Abstract
Chronic pelvic pain affects 2–24% of women in the reproductive period. There are various causes of chronic pelvic pain in women including gynecologic, urologic, gastrointestinal, and musculoskeletal problems. The treatment of pain is directed toward the underlying pathology. However, in some cases, no pathology can be found, and sometimes, more than one underlying pathology may be found in the same patient. Surgical denervation methods may be used in the treatment of chronic pelvic pain in women including uterosacral nerve ablation and presacral neurectomy. Uterosacral nerve ablation has been used as a treatment method for uterine causes of pelvic pain. It has been used widely in the treatment of dysmenorrhea- and endometriosis-related pain. But recent randomized studies and meta-analysis have questioned the effect of uterosacral nerve ablation in the treatment of chronic pelvic pain. Presacral neurectomy involves damage of the uterine sympathetic innervation at the level of superior hypogastric plexus. It is effective in the treatment of midline pelvic pain. It has been found to be more effective than laparoscopic uterosacral nerve ablation in a randomized study. The method, effect, and studies evaluating uterosacral nerve ablation and presacral neurectomy will be discussed in this chapter.
Highlights
Chronic pelvic pain (CPP) is a constant or recurrent pain and generally defined as lasting for more than 6 months, and clinically carries significant physical, functional, and psychological impacts that have an adverse effect on quality of life
There was no significant difference between laparoscopic uterosacral nerve ablation (LUNA) and presacral neurectomy in the treatment of dysmenorrhea in the short-term follow-up; laparoscopic presacral neurectomy was more effective than LUNA in the long term
Initial case series have shown promising results, both prospective and randomized controlled studies have shown that LUNA had no significant effect in the cure of CPP, but it may have a beneficial effect in some patients with pelvic pain and primary dysmenorrhea
Summary
Chronic pelvic pain (CPP) is a constant or recurrent pain and generally defined as lasting for more than 6 months, and clinically carries significant physical, functional, and psychological impacts that have an adverse effect on quality of life. In the presence of obvious etiological factors, it should be treated Even in these patients, targeted therapy may not result in resolution of pain. The pain fibers from the ovary and distal fallopian tubes go through the ovarian plexus to the vagus nerve Because these fibers join with the superior hypogastric plexus, pelvic denervation procedures are only indicated for patients with midline pelvic pain. Pelvic denervation procedures are indicated in women with chronic pelvic pain with a predominant midline component who desire to maintain their reproductive potential and fail or have contraindications to medical management [7]. Patients with endometriosis who have midline chronic pelvic pain, pelvic denervation interventions improve pain when combined with surgical excision of endometriosis [8]
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