title: Recognition and treatment of endometriosis involving the sacral nerve roots.
abstract: OBJECTIVE
  Endometriosis involving the sacral plexus is still poorly understood or neglected by many surgeons. Looking at that scenario, we have designed this educational video to explain and describe the symptoms suggestive of endometriotic involvement of the sacral plexus in addition to the technique for the laparoscopic treatment of this condition.
  
  
  METHODS
  Retrospective analysis of 13 consecutive cases of endometriotic entrapment of nerves of the lumbosacral plexus.
  
  
  RESULTS
  Paired t test revealed a statistically significant (p < 0.0000001) reduction in pain VAS score, from preoperative average 9.1 (±1.98) to postoperative 1.46 (±1.66). Twelve out of 13 patients (92.3%) experienced a reduction of 50% or more in VAS score and 6 (46.15%) became completely pain-free.
  
  
  CONCLUSIONS
  The signs suggestive of intrapelvic nerve involvement include perineal pain or pain irradiating to the lower limbs, lower urinary tract symptoms, tenesmus or dyschezia associated with gluteal pain. Whenever deeply infiltrating lesions are present, the patient must be asked about those symptoms and specific MRI sequences for the sacral plexus must be taken, so that the equipment and team can be arranged and proper treatment performed.
authors.affiliation: Pelvic Neurodysfunction Clinic of the Department of Obstetrics and Gynecology of the Federal University of São Paulo, Rua Jose de Magalhaes, 373 ap904., São Paulo, SP, Brazil, CEP: 04026-090. nucelio@gmail.com.
authors.forename: Nucelio
authors.initials: N
authors.lastname: Lemos
authors.affiliation: Hospital Samaritano de São Paulo, São Paulo, SP, Brazil.
authors.forename: Nicolau
authors.initials: N
authors.lastname: D'Amico
authors.affiliation: Pelvic Neurodysfunction Clinic of the Department of Obstetrics and Gynecology of the Federal University of São Paulo, Rua Jose de Magalhaes, 373 ap904., São Paulo, SP, Brazil, CEP: 04026-090.
authors.forename: Renato
authors.initials: R
authors.lastname: Marques
authors.affiliation: Pelvic Neurodysfunction Clinic of the Department of Obstetrics and Gynecology of the Federal University of São Paulo, Rua Jose de Magalhaes, 373 ap904., São Paulo, SP, Brazil, CEP: 04026-090.
authors.forename: Gil
authors.initials: G
authors.lastname: Kamergorodsky
authors.affiliation: Pelvic Neurodysfunction Clinic of the Department of Obstetrics and Gynecology of the Federal University of São Paulo, Rua Jose de Magalhaes, 373 ap904., São Paulo, SP, Brazil, CEP: 04026-090.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Schor
authors.affiliation: Pelvic Neurodysfunction Clinic of the Department of Obstetrics and Gynecology of the Federal University of São Paulo, Rua Jose de Magalhaes, 373 ap904., São Paulo, SP, Brazil, CEP: 04026-090.
authors.forename: Manoel J B C
authors.initials: MJ
authors.lastname: Girão
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D005260:Female; D052776:Female Urogenital Diseases / Q000150:complications*; D006801:Humans; D010535:Laparoscopy; D008160:Lumbosacral Plexus; D009408:Nerve Compression Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D017699:Pelvic Pain; D012189:Retrospective Studies; D013126:Spinal Nerve Roots
keywords: Deeply infiltrating endometriosis; Laparoscopy; Lumbosacral plexus; Pudendal pain; Sciatica; Urinary symptoms