title: Vascular entrapment of the sciatic plexus causing catamenial sciatica and urinary symptoms.
abstract: Pelvic congestion syndrome is a well-known cause of cyclic pelvic pain (Ganeshan et al., Cardiovasc Intervent Radiol 30(6):1105-11, 2007). What is much less well known is that dilated or malformed branches of the internal or external iliac vessels can entrap the nerves of the sacral plexus against the pelvic sidewalls, producing symptoms that are not commonly seen in gynecological practice, such as sciatica, or refractory urinary and anorectal dysfunction (Possover et al., Fertil Steril 95(2):756-8. 2011). The objective of this video is to explain and describe the symptoms suggestive of vascular entrapment of the sacral plexus, as well as the technique for the laparoscopic decompression of these nerves.
  
  
  METHODS
  Two anecdotal cases of intrapelvic vascular entrapment are used to review the anatomy of the lumbosacral plexus and demonstrate the laparoscopic surgical technique for decompression at two different sites, one on the sciatic nerve and one on the sacral nerve roots.
  
  
  RESULTS
  After surgery, the patient with the sciatic entrapment showed full recovery of the sciatica and partial recovery of the myofascial pain. The patient with sacral nerve root entrapment showed full recovery with resolution of symptoms.
  
  
  CONCLUSIONS
  The symptoms suggestive of intrapelvic nerve entrapment are: perineal pain or pain irradiating to the lower limbs in the absence of a spinal disorder, and lower urinary tract symptoms in the absence of prolapse of a bladder lesion. In the presence of such symptoms, the radiologist should provide specific MRI sequences of the intrapelvic portion of the sacral plexus and a team and equipment to expose and decompress the sacral nerves should be prepared.
authors.affiliation: Pelvic Neurodysfunction Clinic of the Department of Obstetrics and Gynecology, Federal University of São Paulo, Rua Jose de Magalhaes, 373 ap904., São Paulo, SP, CEP: 04026-090, Brazil. nucelio@gmail.com.
authors.forename: Nucelio
authors.initials: N
authors.lastname: Lemos
authors.affiliation: Pelvic Neurodysfunction Clinic of the Department of Obstetrics and Gynecology, Federal University of São Paulo, Rua Jose de Magalhaes, 373 ap904., São Paulo, SP, CEP: 04026-090, Brazil.
authors.forename: Renato Moretti
authors.initials: RM
authors.lastname: Marques
authors.affiliation: Pelvic Neurodysfunction Clinic of the Department of Obstetrics and Gynecology, Federal University of São Paulo, Rua Jose de Magalhaes, 373 ap904., São Paulo, SP, CEP: 04026-090, Brazil.
authors.forename: Gil
authors.initials: G
authors.lastname: Kamergorodsky
authors.affiliation: Pelvic Neurodysfunction Clinic of the Department of Obstetrics and Gynecology, Federal University of São Paulo, Rua Jose de Magalhaes, 373 ap904., São Paulo, SP, CEP: 04026-090, Brazil.
authors.forename: Christine
authors.initials: C
authors.lastname: Ploger
authors.affiliation: Pelvic Neurodysfunction Clinic of the Department of Obstetrics and Gynecology, Federal University of São Paulo, Rua Jose de Magalhaes, 373 ap904., São Paulo, SP, CEP: 04026-090, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Schor
authors.affiliation: Pelvic Neurodysfunction Clinic of the Department of Obstetrics and Gynecology, Federal University of São Paulo, Rua Jose de Magalhaes, 373 ap904., São Paulo, SP, CEP: 04026-090, Brazil.
authors.forename: Manoel J B C
authors.initials: MJ
authors.lastname: Girão
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D008022:Ligaments / Q000473:pathology / Q000601:surgery; D059411:Lower Urinary Tract Symptoms / Q000209:etiology; D009408:Nerve Compression Syndromes / Q000209:etiology* / Q000601:surgery; D012584:Sciatic Nerve; D012585:Sciatica / Q000209:etiology; D012810:Sigmoid Diseases / Q000150:complications* / Q000601:surgery; D054079:Vascular Malformations / Q000150:complications* / Q000601:surgery; D014680:Veins / Q000002:abnormalities / Q000601:surgery
keywords: Laparoscopy; Nerve entrapment syndrome; Pelvic congestion syndrome; Sciatica; Urinary incontinence; Vulvodynia