8887 Hysteroscopic Intramyometrial Injection of Botulinum Toxin As Treatment for Chronic Pelvic PAIN of Uterine Origin

Abstract

<h3>Study Objective</h3> to demonstrate the surgical technique of the intramyometrial application of botulinum toxin Hysteroscopic approach for the management of pelvic pain of uterine origin. <h3>Design</h3> A step-by-step description was made for the application of intramyometrial botulinum toxin via hysteroscopic. <h3>Setting</h3> Advanced gynecology laparoscopic and pelvic pain unit. <h3>Patients or Participants</h3> Patients with painful uterine syndrome who follows the diagnostic criteria: the presence of localized pain in the pelvis, colic or sensation of uterine contraction outside the cycle, dysmenorrhea, dyspareunia, physical examination findings of pain on uterine palpation as a uterine trigger. <h3>Interventions</h3> hysteroscopic Intramyometrial application of Botulinum Toxin for treatment of chronic pelvic pain of uterine origin. <h3>Measurements and Main Results</h3> Intramyometrial application of botulinum toxin under hysteroscopic guidance with general anesthesia, use of Bettochi's hysteroscope and surgical steel needle for cystoscopy (5 Fr, 30 cm) through the working channel, use of saline solution as a means of distention, vaginoscopy, entry into the endocervical canal and endometrial cavity, evaluation of the cavity, location of the ostium, injection of botulinum toxin type A dilution (200 IU in 20 cc SSN) application of 1 cc per point distributed on the anterior and posterior face of the uterine wall. <h3>Conclusion</h3> Hysteroscopic intramyometrial application of Botulinum toxin can be a treatment option in patients with chronic pelvic pain of uterine origin when conventional treatment fails. It is an easily reproducible procedure, with few side effects and effective in pain control in selected patients.