Surgery For Chronic Pelvic Pain Research Articles

RACIAL DIFFERENCES IN ENDOMETRIOSIS – A REFLECTION OF WHO PROCEEDS WITH SURGERY FOR PELVIC PAIN?

Endometriosis is thought to be more prevalent in White women than Black women. Few studies have reported whether reported racial differences in the prevalence of endometriosis can be explained by racial disparities in access to surgery for chronic pelvic pain. We aimed to identify whether patient factors such as race were associated with whether women with pelvic pain proceeded to surgery or were diagnosed with endometriosis.

1836 Outcomes of Laparoscopic Management of Chronic Pelvic Pain and Endometriosis

Study Objective To analyze the rate of re-operation and pelvic pain outcomes for patients who underwent laparoscopic surgery for chronic pelvic pain and endometriosis. Secondary objectives were to study the impact of surgery on quality of life and fertility outcomes. Design This is a retrospective study and a prospective online or telephone questionnaire of patients who underwent laparoscopic surgery for pelvic pain and/or endometriosis. The 12-Item Short Form Health Survey (SF-12) and the Female Sexual Function Index (FSFI) were used in part to develop the prospective questionnaire. Setting Tertiary care university referral center for minimally invasive gynecologic surgery. Patients or Participants Sixty-nine patients who underwent laparoscopic surgery for chronic pelvic pain. Interventions Retrospective chart review and prospective telephone or internet-based questionnaire. Measurements and Main Results Sixty-nine subjects consented and filled out a comprehensive questionnaire. Mean follow-up time was 28.3 months. Forty-three subjects who completed the questionnaire were visually found to have endometriosis. The rate of reoperation was 8.60% for patients with pathologic confirmation of endometriosis. 23.3% of patients with endometriosis underwent hysterectomy. The rate of re-operation was 9.09% for patients who did not undergo hysterectomy. 67.4% of patients with endometriosis were still pain-free at the time of the survey. The rate of re-operation for those without endometriosis was 0%. 30.2% of patients with endometriosis had a history of infertility for an average of 1.889 years prior to surgery. Following surgery, 83.3% of previously infertile patients with endometriosis attempted to conceive with 80.0% success rate. Subjects had significant improvement in each quality of life measurement and most sexual function indices analyzed. Conclusion Laparoscopic surgery for endometriosis had a low rate of re-operation, and long-term improvement in pelvic pain, sexual function, quality of life and fertility outcomes, with a high satisfaction rate.

Outcomes in Women Undergoing Conservative Compared to Definitive Surgery for Chronic Pelvic Pain: A Prospective Cohort

Study Objective To compare chronic pelvic pain and quality-of-life outcomes in women undergoing conservative or definitive surgery for pelvic pain. Design A prospective cohort analytic study (Canadian Task Force Classification II-2). Setting A tertiary referral center for endometriosis in Vancouver, Canada. Patients or Participants A total of 676 patients underwent surgical interventions for pelvic pain between December 2013 and July 2016. 517 patients underwent conservative surgery whereas 159 patients underwent definitive surgery. Interventions Patients underwent either conservative or definitive surgery for chronic pelvic pain. Conservative surgery was defined as excision and/or cautery of endometriosis. Definitive surgery involved a hysterectomy and/or bilateral salpingo-oophorectomy. Measurements and Main Results Chronic pelvic pain (differentiated from dysmenorrhea or dyspareunia) was determined at baseline, 1-year, and 2-years on a patient-reported numeric rating scale (0-10). Similarly, the Endometriosis Health Profile (EHP)-30 questionnaire functional pain scale (0-100%, lower score indicating better quality-of-life) was determined at baseline, 1 year, and 2 years. The average age of women undergoing surgery was 34 ± 8 for conservative surgery and 39 ± 6 for definitive surgery. There was no statistically significant difference in self-reported chronic pelvic pain between the two groups at baseline (7 ± 2 vs. 7 ± 2, p = 0.35), at 1-year (6 ± 2 vs. 6 ± 2, p = 0.56), or at 2-years (6 ± 2 vs. 6 ± 3, p = 0.51). For quality-of-life, there was no difference in baseline EHP-30 scores (54% vs. 57%, p = 0.31). However, a statistically significant difference in EHP-30 scores was identified for definitive vs. conservative surgery at 1-year (34% vs. 20%, p Conclusion There was no difference in self-reported chronic pelvic pain after follow-up from conservative vs. definitive surgery. However, definitive surgery (hysterectomy +/- BSO) was associated with improved quality-of-life. This improvement may be a result of the elimination of dysmenorrhea.

MicroRNA expression pattern differs depending on endometriosis lesion type.

MicroRNA (miRNA), noncoding segments of RNA involved in post-transcriptional regulation of protein expression are differentially expressed in eutopic endometrium of women with and without endometriosis compared to endometriotic lesions. However, endometriotic lesion types are known to be biochemically distinct and therefore hypothesized that miRNAs are differentially expressed in endometriomas compared to peritoneal and deep-infiltrating lesions. Therefore, endometrial biopsies and ectopic implants from women (n=38) undergoing laparoscopic surgery for chronic pelvic pain were collected. Samples of endometriomas, peritoneal or deep-infiltrating lesions were selected from our tissue bank for study participants who exclusively had only one lesion type noted on their surgical report. Quantitative real-time polymerase chain reaction for miR-9, miR-21, miR-424, miR-10a, miR-10b, and miR-204 was performed. miR-204 expression was significantly lower (P=0.0016) in the eutopic endometrium of women with endometriosis compared to controls. Relative expression of miR-21, miR-424, and miR-10b differed significantly (P<0.05) across endometriotic lesion types. Finally, all miRNAs isolated from endometriomas, peritoneal and deep-infiltrating lesions studied were differentially expressed compared to matched eutopic endometrium samples. We therefore conclude that miRNA expression in the eutopic endometrium from women with endometriosis differs from symptomatic controls. Moreover, miRNA expression pattern is dependent on the endometriotic lesion type studied. We suggest that identification of different miRNA expression patterns for endometriomas, peritoneal and deep-infiltrating lesions could contribute to individualized patient care for women with endometriosis.

Laparoscopic Appendectomy in Women Without Identifiable Pathology Undergoing Laparoscopy for Chronic Pelvic Pain

To assess the effectiveness of appendectomy in women undergoing laparoscopy for chronic pelvic pain without identifiable pathology. This retrospective cohort study included women aged 15 to 50 years who underwent laparoscopic surgery for chronic pelvic pain without identifiable pathology. The cohort was divided into 2 groups: women who underwent appendectomy and women who had not undergone appendectomy at laparoscopic surgery. Postoperative pain was assessed at 6-week follow-up and by subsequent mailed questionnaire. Women who underwent appendectomy (n = 19) were significantly more likely to report improvement in pain at 6-week follow-up than women who did not undergo appendectomy (n = 76) (93% vs 16%; P < .001). Thirty-six patients (38%) responded to the questionnaire at a median of 4.2 years after surgery, when the median change (improvement) in reported pain was greater in the appendectomy group than in the nonappendectomy group. Appendectomy is effective therapy for patients with chronic pelvic pain of unknown etiology who are undergoing laparoscopy.

Urinary Dysfunction after Laparoscopic Surgery for Chronic Pelvic Pain Related to Pelvic Endometriosis; Postoperative Evaluation and Management

Urinary Dysfunction after Laparoscopic Surgery for Chronic Pelvic Pain Related to Pelvic Endometriosis; Postoperative Evaluation and Management

Pressure-Pain Sensitivity May Be Correlated with Persistent Pelvic Pain Following Surgery for Chronic Pelvic Pain

Pressure-Pain Sensitivity May Be Correlated with Persistent Pelvic Pain Following Surgery for Chronic Pelvic Pain

Evaluation of a new questionnaire for the presurgical diagnosis of bladder endometriosis

The main objective was to evaluate the diagnostic accuracy of a new questionnaire for the presurgical diagnosis of bladder endometriosis in patients with a high suspicion index for this disease. We included all patients of age <40 years undergoing laparoscopy or laparotomy for chronic pelvic pain. We partially modified the American Urologic Association Symptom Index with the aim of identifying bladder endometriosis among 157 women undergoing surgery for chronic pelvic pain. All patients underwent preoperative ultrasonography; selected patients, with suspected bladder endometriosis, underwent computed tomography and cystoscopy. The physicians performing both the preoperative evaluation and surgery were blinded to the questionnaires' results. A total of 127 (81%) patients had pelvic endometriosis, 14 (8.9%) had bladder endometriosis. The questionnaires' score for patients with and without bladder endometriosis was 21 +/- 8.7 and 4.6 +/- 5.7, respectively (P < 0.0001). The area under the receiver operating characteristic curve was 0.951. With a cut-off of 9, sensitivity was 93% and specificity 88%. The questionnaire proved to be effective in identifying bladder endometriosis, allowing a proper diagnostic work-up and surgical treatment, and minimizing the risk of recurrence. In this primary referral centre for endometriosis the prevalence of the disease was high-therefore it may achieve a lower diagnostic accuracy when evaluated on a population of women with a lower prevalence of bladder endometriosis.

Medical Tx Rivals Surgery for Chronic Pelvic Pain

Medical Tx Rivals Surgery for Chronic Pelvic Pain

Laparoscopic appendectomy in patients with endometriosis

Study objective To report the frequency and spectrum of histologically proved diseases of the appendix in patients undergoing laparoscopic surgery for chronic pelvic pain in conjunction with endometriosis in a tertiary referral center. Design Patient database with retrospective chart review (Canadian Task Force classification II-3). Setting University ambulatory endoscopic surgery center—tertiary referral center. Patients Two hundred thirty-one women. Interventions Appendectomy during laparoscopic surgery for endometriosis. Measurements and main results We reviewed the medical records of 231 patients who underwent appendectomy during laparoscopic treatment of endometriosis performed from January 1994 through July 2004. Of the 231 patients with pelvic endometriosis, concomitant appendiceal pathology was present in 115. Conclusion The appendix may be involved and may contribute to pelvic pain in patients with endometriosis.

Changes in personality profile associated with laparoscopic surgery for chronic pelvic pain

To determine whether surgical treatment of chronic pelvic pain is associated with changes in personality profile. Prospective clinical trial (Canadian Task Force classification II-2). University-affiliated tertiary referral center. Sixteen women undergoing laparoscopic surgery for evaluation and treatment of chronic pelvic pain. Before and 3 months after surgery all subjects completed the Minnesota multiphasic personality inventory-2 and the West Haven-Yale multidimensional pain inventory. Laparoscopic surgery for chronic pelvic pain was associated with a postoperative decrease in pain severity score by 53% (p <0.001), increase in activity level score by 24% (p <0.001), decrease in hypochondriasis score by 6% (p = 0.049), decrease in depression score by 12% (p = 0.007), and decrease in conversion hysteria score by 7% (p = 0.02). Improvements in pain severity and activity level were comparable in women with abnormal and normal preoperative scores of hypochondriasis, depression, and conversion hysteria. Improvement in chronic pelvic pain is associated with an improvement in personality profile. Abnormal versus normal preoperative scores for hypochondriasis, depression, or conversion hysteria scales are not predictive of change in pain or activity level after surgery.