The Anatomical Distribution of Pelvic Deep Infiltrating Endometriosis and Its Relationship with Pain Symptoms

Abstract

Study Objective: The aim of the study was to investigate the relationship between the anatomical distribution of DIE lesions and pain symptoms. Design: Clinical prospective control study. Setting: Peking Union Medical College Hospital, the National Continuing Education Center for Gynecology Laparoscopic Surgery. Patients: Clinical data from 354 patients with laparoscopically diagnosed endometriosis were analyzed, including 177 DIE and 177 non-DIE patients. Intervention: All patients with endometriosis had laparoscopic surgery. Measurements and Main Results: For each patient, demographic data were collected with the pain symptoms before the surgery, including dysmenorrhea, chronic pelvic pain, deep dyspareunia and dyschezia. The severity of these pain symptoms were defined according to the Visual Analogue Scoring system. All visible peritoneal lesions or abnormal-appearing peritoneum at laparoscopy were excised or biopsied. Endometriotic lesions were identified by anatomical sites, colors, numbers and depth of infiltration. The sizes of any measurable nodules were recorded by the histopathologists. Result:T he duration of pain suffering in DIE patients was significantly longer than that of non-DIE patients (13.8 vs 5.2 years p<0.01).When compared with non-DIE patients, DIE patients had significantly higher incidences of bilateral uterosacral ligament nodules (60.7%), completely obliterated cul-de-sacs (44.6%), rectal invasion (19.9%) and pelvic adhesions. Up to 98.4% of the DIE lesions were located in the posterior pelvic compartment. DIE lesions were found in the bladder (1.6%), uterosacral ligament (67%), cul-de-sac (12%), recto-vaginal septum (12.7%), rectum and rectosigmoid junction (2.9%) and ureter (3.8%). Patients with DIE also presented with more severe dysmenorrhoea, chronic pelvic pain, deep dyspareunia and dyschezia. The location and depth of endometriotic infiltration were significantly correlated with the endometriosis-related pain symptoms. Conclusion: DIE lesions were associated with severe pain symptoms. The main distribution of DIE lesions was in the posterior pelvic compartment, and was more widespread and severe in DIE patients.