Abstract
The aim of this work is to explore the efficacy , safety, and patients' satisfaction of laparoscopic uterosacral nerve ablation (LUNA) in relief of pain in women with chronic pelvic pain in whom diagnostic laparoscopy reveals either no pathology or mild endometriosis (AFS score ≤5). The study was a prospective, single-blind, randomized trial with 12 months follow-up. It was conducted at the endoscopy unit of the Gynecology Department of El Minia University Hospital, Egypt. One hundred ninety Egyptian women consented to participate in the study. These eligible patients were randomized using computer-generated tables and were divided into two equal groups, including the control group (diagnostic laparoscopy with no pelvic denervation) and the study group (diagnostic laparoscopy plus LUNA). Diagnostic laparoscopy with or without laparoscopic uterosacral nerve ablation was done. There were no statistically significant difference between both groups regarding the efficacy and the overall success rate (between group I and group II, it was 77.64%, 76.47%, and 74.11% versus 79.06%, 75.58%, and 73.25% at 3, 6, and 12 months, respectively) and the cumulative patients' satisfaction rate (it was 74.11%, 74.11%, and 71.76% versus 75.58%, 75.58%, and 72.09% at 3, 6, and 12 months between group I and group II, respectively; P ≤ 0.05). There was no statistically significant difference between both groups as regards the effectiveness of LUNA in the treatment of primary (spasmodic) and secondary (congestive) dysmenorrhea (P ≤ 0.05), while there was a statistically significant difference between both groups in the treatment of dyspareunia (P ≥ 0.05). LUNA can be a last alternative option in well-selected patients for control of chronic pelvic pain without endometriosis; however, its effectiveness may not extend to other indications. Also, preliminary experience in the treatment of primary deep dyspareunia presents a promising perspective on the management of deep dyspareunia, especially if it will involve a team of social, psychological, and gynecological specialists.
Highlights
Chronic pelvic pain (CPP) can be defined as intermittent or constant pain in the lower abdomen or pelvis of at least 6 months’ duration, not occurring exclusively with menstruation or intercourse, and not associated with pregnancy; it is a symptom, not a diagnosis and dysmenorrhea, deep dyspareunia, and intermenstrual pain constitute its main symptom complex [1]
laparoscopic uterosacral nerve ablation (LUNA) can be a last alternative option in well-selected patients for control of chronic pelvic pain without endometriosis; its effectiveness may not extend to other indications
Preliminary experience in the treatment of primary deep dyspareunia presents a promising perspective on the management of deep dyspareunia, especially if it will involve a team of social, psychological, and gynecological specialists
Summary
Chronic pelvic pain (CPP) can be defined as intermittent or constant pain in the lower abdomen or pelvis of at least 6 months’ duration, not occurring exclusively with menstruation or intercourse, and not associated with pregnancy; it is a symptom, not a diagnosis and dysmenorrhea, deep dyspareunia, and intermenstrual pain constitute its main symptom complex [1]. CPP is one of the commonest symptomatology in gynecological outpatient clinics. It accounts for 10% of office visits to gynecologists, general clinics, and about a quarter of outpatient consultations in general gynecological practice and for 40–60% of all diagnostic laparoscopies [2]. In our department, it varies from 40–46% of all diagnostic laparoscopy annually. Laparoscopy is a valuable tool in the evaluation of undiagnosed CPP, as it can establish a definite diagnosis and modify the treatment without resorting to exploratory laparotomy [3]. Recent developments in minimal access surgery using laparoscopy make ablation of the nerve plexuses and ganglions in the uterosacral ligaments (laparoscopic uterosacral nerve ablation (LUNA)) a practicable treatment option [4]
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