Pelvic Pain Research Articles (Page 1)

BACKGROUND Tuberculosis remains a global health issue, with 25% of the population carrying latent infection and 5-10% at risk of active disease. In 2021, 10.6 million people were affected and 1.6 million died. While pulmonary TB is most common, extrapulmonary cases are rising. Female genital TB accounts for 5-30% of infertility worldwide. Endometrial TB often begins asymptomatically but can cause menstrual disorders, pelvic pain, and infertility. This study evaluated the clinical value of negative-pressure endometrial sampling in screening endometrial TB. MATERIAL AND METHODS Eighty-four patients suspected of having endometrial TB (April 2021-April 2023) were enrolled and divided into a negative-pressure aspiration group (n=48) and a fractional curettage group (n=36). Sampling pain (FRS score), time, satisfaction, diagnostic efficiency, and safety were compared. RESULTS The negative-pressure aspiration group had a significantly lower FRS score and a significantly shorter sampling time than the fractional curettage group (P<0.05). There was a significant difference in the distribution of populations with different satisfaction between the 2 groups (P<0.05). Through comparison with the pathological examination results of surgical samples which were set as the criterion standard, the kappa value was 0.692 in the negative-pressure aspiration group, higher than that in the fractional curettage group (0.667). The negative-pressure aspiration group had significantly higher sensitivity and significantly lower specificity compared with the fractional curettage group (89.66% vs 80.00%, P<0.05, 78.95% vs 87.50%, P<0.05). CONCLUSIONS During the screening of endometrial tuberculosis, negative-pressure endometrial sampling technology has a high sensitivity, can reduce the pain sensation during sampling and sampling time, and can improve patient satisfaction with sampling.

Quality of Descriptions of Pelvic Floor Muscle Training Prescribed to Women With Dyspareunia: A Systematic Review.

Prostatitis is a common urological condition worldwide, with nonbacterial chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), classified as National Institutes of Health (NIH) category III prostatitis, being the most prevalent form. This study aimed to elucidate the molecular mechanism underlying pain in CP/CPPS by investigating the expression of key pain-transducing ion channels: acid-sensing ion channel type 3 (ASIC3), purinergic channel P2X type 3 (P2X3), and transient receptor potential vanilloid type 1 (TRPV1) in the dorsal root ganglia (DRG) innervating the prostate. Prostatic inflammation was induced in male Wistar rats via bilateral intraprostatic injections of carrageenan (25µl of 3% w/v in sterile saline). Seventy-two hours post-surgery, immunohistochemistry and quantitative real-time polymerase chain reaction (RT-PCR) were performed to assess the localization and expression of ASIC3, P2X3, and TRPV1 ion channel proteins. Our study demonstrated a significantly increased expression of the channels P2X3 and TRPV1 in the L5-L6 DRG of rats with experimentally induced prostatitis. These findings provide evidence for the possible involvement of these ion channels in the generation and/or maintenance of pain in CP/CPSS, suggesting they may serve as potential drug targets for the development of effective treatments. The study aimed to explore the molecular mechanisms underlying pain in CP/CPPS by identifying the ion channel transducers involved in this debilitating condition. This could lead to the recognition of novel therapeutic targets and facilitate the drug discovery process for treating prostatitis-associated pelvic pain.

A secondary analysis of the PROPEL study (gov-Identifier: NCT00638235) data was conducted to compare symptom prevalence preoperatively vs. 6months after transvaginal prolapse repair with Elevate anterior and/or posterior. Symptoms were assessed with the pelvic floor distress inventory questionnaire (PFDI). Two hundred seventy-seven women with symptomatic II-IV stage POP underwent mesh-supported vaginal sacrospinous ligament fixation. Of these women, 187 (67%) reported at least one pain symptom of moderate or quite a bit severity preoperatively (anterior n = 105, visceral n = 129, posterior n = 122). Of these women reporting pain, approximately 40-64% had coexisting symptoms of urinary urgency, daytime urinary urgency, urinary urgency-incontinence, and nocturia of moderate or quite a bit severity. A smaller part reported coexisting symptoms of underactive bladder (UAB), fecal incontinence (FI), and/or obstructive defecation (OD). Sixmonths postoperatively, a significant reduction in the prevalence of almost all symptoms was observed. Cure rates for symptoms of overactive and underactive bladder were 65-85%, for symptoms of FI and OD 51-71%, and 58% (posterior), 85% (visceral), and 82% (anterior) for pain, respectively. The coexistence of bothersome pain, bladder, and bowel symptoms is common in women with POP. Therefore, POP should always be ruled out as a differential diagnosis before classifying the symptoms as interstitial cystitis/bladder pain syndrome. Women with POP and the co-existing symptoms described should be advised that surgical POP repair can resolve these symptoms in a high percentage.

Background Little is known about the effect of including pelvic floor muscle relaxation exercises (PFMRE) in a physiotherapy management plan for pelvic pain. Aims This retrospective study evaluated the effect of PFMRE audio files on pelvic pain. It was hypothesised that audio files guiding PFMRE would result in less self-reported pain on digital examination of the pelvic floor muscles. Methods Patient files from a private pelvic health physiotherapy practice were assessed for reports of pain during pelvic floor muscle examination, pre- and post-PFMRE, between August 2020 and August 2022. All patients had chronic pelvic pain, were examined by the same practitioner, and used the same audio files (produced by the treating practitioner). A numerical rating scale (NRS) was used to rate pain. Examinations were conducted approximately 4 weeks apart. Results Fifty-eight patients were eligible to be part of this study. There was a significant decrease in self-reported pain post-PFMRE treatment in both the superficial (mean pain score 2.21 (s.d. 2.33), P &amp;lt; 0.001) and deep pelvic floor muscles (mean pain score 1.12 (s.d. 1.99), P &amp;lt; 0.001). Effect sizes of 2.15 and 2.46 were found for the superficial and deep pelvic floor muscle respectively. Conclusion Pelvic floor muscle relaxation exercise audio files appear to be a useful treatment adjunct to reduce self-reported pain during examination of the pelvic floor muscles. This provides initial insight into how relaxation strategies may fit into multi-modal physiotherapy management programs for chronic pelvic pain. Limitations include the fact that patients were adhering to other treatment advice from the treating practitioner and management advice from other health professionals in their team at the same time.

The current treatment of provoked vestibulodynia involving neuroproliferation is often complete vestibulectomy; however, less invasive treatments are biologically plausible, yet lack study. The International Society for the Study of Women's Sexual Health, the National Vulvodynia Association, the Gynecologic Cancers Research Foundation, and Tight Lipped, a grassroots nonprofit organization that supports people with chronic vulvovaginal and pelvic pain, collectively sponsored a conference, the Vulvodynia Therapeutic Research Summit, held in April 2024. The primary objective of the Vulvodynia Therapeutic Research Summit was to identify options for further research of the treatment of provoked vestibulodynia through expert consensus. After the conference, attendees scored the presented therapeutics in rank order, leading to a hierarchy of merit. Fifteen therapeutic options were presented and ranked in order of most promising to least promising for further study on treating the neuroinflammation of provoked vestibulodynia. The top identified therapeutics for further research were: 1) ketotifen fumarate (mast cell stabilizer with potential to prevent mast cell activation), 2) resiniferatoxin (transient receptor vanilloid 1 agonist causing chemo-inactivation of nerve terminals), 3) specialized pro-resolving mediators or strategies to boost their levels (eg, maresin 1 and 1-trifluoromethoxy-phenyl-3-(1-propionylpiperidin-4-yl) urea), 4) luteolin (flavonoid with potent anti-inflammatory, antioxidant, and neuroprotective properties), 5) alpha-lipoic acid (antioxidant with nerve-specific anti-inflammatory and mast cell stabilizing qualities), and 6) NGFR121W-SNAP IR700 trimer exposed to near-infared light (photoablation targeting nociceptors and sparing surrounding tissue). This executive summary describes the rationale for identifying specific pharmacologic agents and medical devices as targets for research directed toward treatment of the neuroinflammatory process found in the vestibular mucosa of provoked vestibulodynia.

Real Time Nerve Mapping for Endometriosis Involving the Sciatic & Pudendal Nerves.

Peripheral nerve stimulation (PNS) has emerged as a promising neurostimulation modality, yet its effectiveness and durability for chronic pain remain uncertain. We conducted a systematic review and meta-analysis to evaluate changes in pain intensity following implantable PNS therapy. Eligible studies included adults (≥18 years) with chronic pain treated with an implantable PNS system, and pain intensity was assessed at baseline and follow-up time points. The primary outcome was change in pain intensity from baseline to 6 months after PNS implantation. Secondary outcomes included changes in pain intensity at 3, 12 and 24 months after PNS implantation. Standardized mean differences (Hedges' g) were pooled using a random-effects model. A total of 106 studies comprising 9272 patients were included. PNS was associated with large, statistically significant reductions in pain intensity from baseline to all time points: 3 months (Hedges' g 2.92; 95% CI 2.62 to 3.21), 6 months (Hedges' g 3.08; 95% CI 2.68 to 3.48), 12 months (Hedges' g 2.68; 95% CI 2.30 to 3.05) and 24 months (Hedges' g 2.08; 95% CI 1.68 to 2.48) (all p<0.001). However, the certainty of evidence as assessed by the Grading of Recommendations Assessment, Development and Evaluation criteria was rated as low for the primary outcome, due to pooling from observational studies, risk of bias, and heterogeneity (statistical, clinical and methodological). Subgroup analyses revealed no differences by study design or device type, while smaller effect sizes were reported in industry-funded studies and those with declared conflicts of interest. The largest effect sizes were observed in pelvic and upper extremity pain, whereas the smallest in truncal pain. Implantable PNS provides persistent and clinically meaningful analgesia for chronic pain, with benefits sustained up to 24 months. These findings support broader clinical adoption and provide evidence to inform pay0r coverage and policy decisions.

Background: Heavy menstrual bleeding (HMB) is a prevalent and distressing manifestation among women with ovarian endometrioma, significantly affecting daily life and reproductive health. Evaluating uterine blood flow through Doppler ultrasound provides a non-invasive means to understand the hemodynamic alterations underlying endometriosis-related menstrual dysfunction. This study aimed to assess uterine perfusion parameters and identify clinical predictors of severe HMB in affected women. Objective: To evaluate uterine perfusion indices and determine the key clinical predictors of severe heavy menstrual bleeding in women with ovarian endometrioma. Methods: A cross-sectional study was conducted on 139 women aged 18–45 years with ultrasonographically confirmed ovarian endometrioma and HMB. Demographic and clinical data, including menstrual characteristics, PBAC scores, and pain symptoms, were recorded. Transvaginal Doppler ultrasonography was used to measure the uterine arterial Resistance Index (RI), Pulsatility Index (PI), Peak Systolic Velocity (PSV), End-Diastolic Velocity (EDV), and vessel diameter bilaterally. Statistical analysis was performed using Chi-square, Pearson or Spearman correlation, and multivariable logistic regression to identify predictors of severe HMB (PBAC ≥300). A p-value &lt;0.05 was considered significant. Results: Severe HMB occurred in 61.9% of participants and was significantly associated with chronic pelvic pain (p&lt;0.001), dysmenorrhea (p&lt;0.001), and bilateral endometriomas (p=0.001). Multivariate analysis identified chronic pelvic pain, dysmenorrhea, and bilateral endometriomas as independent predictors of severe bleeding. Mean Doppler indices showed slightly higher RI (0.89±0.04) and PI (2.95±0.20) in the right uterine artery than the left (RI 0.87±0.05; PI 2.88±0.18), suggesting mild lateral variation. No significant associations were observed for age, residence, or BMI. Conclusion: Chronic pelvic pain, dysmenorrhea, and bilateral ovarian endometriomas emerged as strong clinical predictors of severe HMB, highlighting the need for early diagnosis and individualized management. Although Doppler parameters provided valuable insights into uterine hemodynamics, they were not directly correlated with bleeding severity. Integrating clinical and Doppler evaluations can enhance diagnostic precision and inform targeted therapeutic approaches in endometriosis-related HMB.

Endometriosis is a gynecological condition which often causes chronic or recurrent pelvic pain (CPP). The disease can thereby impose a significant burden on affected individuals and their romantic relationships. Existing research highlights the substantial influence of stress, social support, and hormonal factors on pain experience, but data from daily life is scarce. This ecological momentary assessment (EMA) study aimed to explore the association of stress, partners' social support styles, cortisol, and oxytocin in daily life with pain experiences among women with CPP (N = 66) across 7days, resulting in a dataset with up to 2100 data points per variable across multiple measures. Stress was positively correlated with pain ratings both within and between individuals, while no significant associations were observed between salivary cortisol or oxytocin levels and pain ratings. Distracting as well as solicitous social support was positively related to higher pain ratings on a between-person level but showed no or slightly negative associations with pain on a within-person level. These findings suggest that both stress and social support can adversely impact pain experience in endometriosis. This knowledge is essential for developing comprehensive interventions: While stress management can be beneficial, the role of social support is more intricate, requiring tailored guidance for close others and their support behavior.

Background: Physiotherapy plays a crucial role in managing women’s health conditions, such as pelvic pain and postpartum recovery. However, its integration into standard care relies heavily on the awareness and referral practices of gynecologists and obstetricians, which may be suboptimal. Objective: To investigate the awareness, attitudes, and referral practices of gynecologists and obstetricians in Libya regarding the role of physiotherapy in women’s health. Methods: A cross-sectional study was conducted in public and private hospitals in Tripoli, Libya. A total of 100 practitioners were invited to participate. A self-administered questionnaire assessed demographics, awareness, attitudes, and practices. Results: The response rate was 67% (n = 67/100). The results revealed a key disparity: while the vast majority of respondents (94.1%) acknowledged the importance of physiotherapy in women’s health and 76.1% reported a willingness to refer patients, only 67.1% perceived physiotherapists as competent to manage these conditions. This indicates a significant gap in understanding specific physiotherapy techniques. Awareness percentage was significantly influenced by factors such as the type of hospital and prior exposure to physiotherapy education. Conclusions: A striking disparity was found between high general awareness (94.1%) and significantly lower perceived competence (67.1%) and knowledge of its role in specific conditions. This gap between general approval and specific understanding directly creates the critical barrier to referral. To improve interdisciplinary collaboration and patient access to care, enhanced educational initiatives for physicians, the development of clear clinical guidelines, and the establishment of dedicated women’s health physiotherapy clinics are strongly recommended.

Introduction: Patients with malignancy, especially high-grade uterine sarcomas, are at elevated risk for venous thromboembolism (VTE), including deep vein thrombosis (DVT), pulmonary embolism (PE), and intracardiac thrombi. The coexistence of thrombi in the inferior vena cava (IVC), pulmonary arteries, and right heart is rare and potentially life-threatening, even in asymptomatic individuals. Early recognition and intervention are crucial to prevent catastrophic embolic events. Case Presentation: A 48-year-old female with a recent total abdominal hysterectomy for high-grade uterine stromal sarcoma presented for outpatient CT imaging to evaluate disease extent. Imaging revealed extensive IVC thrombus, a small pulmonary embolism, and a possible right atrial thrombus. The patient, who was on prophylactic-dose low molecular weight heparin (Lovenox) and had taken her morning dose, denied leg swelling or pelvic pain. Notably, she had a prior right lower extremity DVT six months earlier following an ankle fracture, treated with a three-month course of anticoagulation. She was referred to the emergency department, where transthoracic echocardiography (TTE) showed a large, mobile thrombus extending into the right atrium and ventricle. She underwent emergent mechanical thrombectomy, with complete removal of the thrombus. Post-procedure transesophageal echocardiography (TEE) confirmed no residual thrombus. Discussion: This case highlights the thrombotic potential in patients with uterine stromal sarcoma, particularly in the postoperative period despite prophylaxis. The development of extensive VTE in the absence of symptoms is a dangerous diagnostic blind spot. The presence of a right heart thrombus, although rare, carries a high mortality risk if left untreated. Prompt use of imaging and mechanical thrombectomy can be life-saving. This case also calls attention to the potential need for therapeutic rather than prophylactic anticoagulation in select high-risk cancer patients. Conclusion: Asymptomatic patients with high-risk malignancies may harbor extensive and life-threatening thrombi despite appropriate prophylaxis. This case underscores the importance of vigilance, comprehensive imaging, and timely intervention in preventing fatal embolic events in oncologic populations.

Pregnancy induces a range of physiological and musculoskeletal changes that can lead to orthopedic issues. This article examines etiologies and management strategies for outpatient orthopedic problems encountered during pregnancy. Hormonal changes, weight gain, and altered biomechanics contribute to common musculoskeletal complaints such as low back pain, pelvic girdle pain, and carpal tunnel syndrome. Although less common, osteoporosis can present during pregnancy. Additionally, domestic violence and interpartner violence are disproportionately more frequent in this population. This review highlights evidence-based approaches for diagnosis and treatment and emphasizes the importance of multidisciplinary care, including obstetricians, orthopedic surgeons, endocrinologists, primary care physicians, and physical therapists.

Background: Female chronic pelvic pain disorders (CPPD) are marked by unpredictable symptom flares, involving both pain and non-pain symptoms that affect the gastrointestinal (GI) and genitourinary (GU) systems. Management is challenging due to limited understanding of pathophysiology and lack of reliable predictors. Heart rate variability (HRV), the measure of small-time differences between heartbeats and an indicator of autonomic nervous system function, has shown promise as a digital biomarker for pain and inflammation. Research Question: This study evaluates whether real-time wearable and patient-tracked data can predict CPPD symptom flares. Methods: The final analytic sample comprised of 311,308 HRV measurements, characterized as RMSSD (root mean square of successive differences) and LF/HF (low frequency/high frequency), across 4,166 person-days from 87 females with CPPD in an observational study using an mHealth application (ehive iOS and android) and Fitbit tracker (model Inspire 3). The primary outcome was the “flare week” score, defined as a 7-day period with more days of disease-specific symptom flares than baseline. The daily “flare score” is the product of the number of CPPD-related pain and GI/GU symptoms with their intensity. Cosinor mixed-effects regression was applied to HRV circadian features: midline-estimating statistic of rhythm (MESOR), amplitude and acrophase. Covariates included age, body mass index (BMI), daily steps, sleep efficiency, and menstrual period. Participant ID and person-level amplitude and acrophase were included as random effects. Results: HRV circadian patterns significantly differed in the week prior to a flare week (Figure 1). RMSSD’s MESOR and amplitude decreased in the preceding week (Table 1), while the acrophase increased (all p&lt;0.05). For LF/HF, the MESOR significantly decreased in a week preceding a flare. Menstrual period was positively associated with RMSSD, while menstrual period, daily step count, and sleep efficiency were inversely associated with LF/HF. Significant interactions for both metrics included obesity with amplitude, period with amplitude and steps with acrophase. There was significant variance in the HRV between-participants based on the significant random effects. Conclusions: We present initial evidence that HRV metrics can predict CPPD symptom fares via non-linear estimation, supporting a promising use of real-time mHealth and wearable data in the context of CPPDs.

Endometriosis is a chronic inflammatory condition, typically associated with pelvic pain and menorrhagia, affecting 10% of women of reproductive age. Inflammation is known to contribute to pregnancy complications, including preterm birth. Recent evidence suggested that women with endometriosis have a higher risk of preterm birth. However, the underlying mechanism remains unclear. Systemic inflammation indices, increasingly used as markers of inflammation in pregnancy-related conditions, may provide insights into this association. In this study, we aimed to investigate whether systemic inflammation contributes to preterm birth in pregnant women with endometriosis. A total of 75 pregnant women with endometriosis confirmed at cesarean sections were included. Clinical and obstetric data were collected and compared with hospital-wide cesarean section data during the same period. Systemic inflammation indices were calculated from peripheral blood tests taken before delivery. Among the 75 women with endometriosis, 15 (20%) experienced preterm birth, which was significantly higher than the 11.4% incidence observed among all other women who delivered by cesarean section at our hospital during the same study period (p = 0.019). The increased incidence of preterm birth was observed across all subtypes of endometriosis. However, systemic inflammation indices, including systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil to lymphocyte ratio (NLR), and pan-immune inflammation value (PIV), derived from blood tests shortly before delivery, did not differ significantly between women with endometriosis who had preterm birth and those who delivered at term. In conclusion, systemic inflammatory indices measured shortly before delivery were not associated with preterm birth in this cohort. Without evaluation of the localized uterine inflammation and systemic inflammation changes earlier in gestation, and the small sample size, our findings are hypothesis-generating and require confirmation in larger studies in the future.

Chronic pelvic pain syndrome (CPPS) in women is a debilitating condition with a high prevalence (5-25%), yet its etiology remains unclear. This prospective observational study aimed to identify clinical and medical history covariates associated with CPPS to elucidate potential pathophysiological mechanisms. A total of 225 women were evaluated in a gynecological pain clinic in Germany, including 41 patients with CPPS (≥ 6months of lower abdominal pain) and 184 control patients undergoing routine gynecological screening. Exclusion criteria included pregnancy, pelvic malignancy, acute pelvic inflammation, and abnormal uterine bleeding. Covariates were assessed through structured clinical history and physical examination. Significant associations with CPPS were observed for prior pelvic surgery (72% vs. 45%, p = 0.003), bowel constipation (37% vs. 11%, p = 0.002), history of endometriosis (33% vs. 10%, p = 0.043), and prior trauma (27% vs. 11%, p = 0.013). In contrast, there were no significant differences in rates of depression (p = 0.376), use of psychopharmaceuticals (p = 0.757), pelvic floor abnormalities (p = 0.503), uterine retroversion (p = 0.330), or pelvic congestion (p = 0.455). Dysmenorrhea (59% vs. 42%) and vulvar pain (31% vs. 8%) were more frequent in the CPPS group, though not statistically significant. No differences were found in delivery mode, use of intrauterine devices, analgesics, hormonal replacement therapy, and other medications, or comorbidities such as diabetes, thyroid disease, hypertension, other pain diseases, or musculoskeletal disorders. CPPS was not associated with several commonly suspected cofactors, including psychosomatic factors, pelvic congestion, or pelvic floor dysfunction. The findings suggest the existence of two subgroups of CPPS, the endometriosis-associated type and the neurovegetative type, associated with prior pelvic surgery, constipation, and trauma. This concept allows for the development of new targeted therapeutic strategies to successfully treat CPPS.

S100A12 correlates with inflammatory and pain symptoms in patients with chronic prostatitis/chronic pelvic pain syndrome.

Efficacy of non-pharmacological therapies in chronic pelvic pain of endometriosis: a systematic review and meta-analysis.

The goal was to develop a pragmatic classification system for conditions associated with chronic pelvic pain (CPP), aiming to enhance diagnosis, management, education, and research of CPP. An international, multidisciplinary panel participated in a modified RAND/UCLA Delphi consensus. This panel included healthcare professionals, medical society representatives, experts, individuals with lived experience of pain, advocacy groups, researchers, educators, and journal editors. The Delphi process comprised three rounds: two online surveys and one virtual meeting. Participants scored their agreement with statements using a 9-point Likert scale (1 = strongly disagree, 9 = strongly agree). A priori criteria for consensus were defined as follows: agreement, a mean score ≥7 with <15% scoring ≤3; disagreement, a mean score ≤3 with <15% scoring ≥7. Responses not meeting these criteria were considered indeterminate and advanced for further refinement in subsequent rounds. In round 1, 65 of 77 (84.4%) stakeholders participated; round 2 consisted of responses from 54 (70.1%) stakeholders, and 34 (44.2%) stakeholders engaged in round 3. The Delphi process yielded broad consensus on the definition of CPP and a corresponding classification system with the acronym R U MOVVING SOMe. This novel system comprises 12 categories: Reproductive, Urinary, Musculoskeletal, Other (not otherwise classified), Vulvovaginal, Vascular, Idiopathic (no pain contributor identified), Neurologic, Gastrointestinal, Sensitization/Nociplastic, Overlapping pain conditions, and Mental health. The R U MOVVING SOMe classification system represents a significant step towards a standardized framework for evaluating CPP. The high level of engagement and consensus among a diverse group of international stakeholders underscores its future potential to improve communication, clinical practice, education, and research in this challenging field.

Isthmocoele is an indentation at the caesarean scar caused by inadequate myometrial healing, leading to symptoms such as abnormal uterine bleeding, pelvic pain and secondary infertility. It appears as a hypoechoic collection at the scar site on transvaginal ultrasound, often with a residual myometrial thickness (RMT) <3 mm. We present a case of a woman in the late 30s, who is a multipara with three prior caesarean sections. She presented with a 2-year history of irregular prolonged intermenstrual bleeding and pelvic pain. Transvaginal sonography revealed a 1.2×1.5 cm niche with RMT of 2.8 mm. As medical therapy failed, she underwent successful laparoscopic isthmocoele repair with complete symptom resolution. A follow-up imaging confirmed restoration of normal uterine anatomy. This case highlights the efficacy of laparoscopic repair in managing symptomatic isthmocoele with thin residual myometrium.