Pelvic Pain Symptoms Research Articles

Utility of Post-Hysterectomy Examinations in Detecting Cuff Dehiscence in Asymptomatic Women

Study Objective To determine detection rates of cuff dehiscence in asymptomatic women at the 6-week post-hysterectomy examination. Design Retrospective cohort Setting Tertiary care academic institution Patients or Participants 2168 women who underwent hysterectomy over a seven-year period Interventions Routine evaluation of vaginal cuff by pelvic examination Measurements and Main Results 2051 women were included in the final analysis. 117 women were excluded due to no documented post-hysterectomy visit (5.7%). There were 1642 women (80.1%) who were asymptomatic at the 6-week post-hysterectomy examination while others endorsed vaginal bleeding (n=122, 5.9%), vaginal discharge (n=101, 4.9%), pelvic pain (n=97, 4.7%) or a combination of symptoms (n=89, 4.4%). Of the asymptomatic women, 1419 had normal findings (90.1%) on exam, 129 demonstrated granulation tissue (8.2%), 68 had no pelvic exam performed (4.8%), 24 had vaginal discharge (1.5%), 2 had partial cuff dehiscence (0.1%), and 0 had complete cuff dehiscence (0%). Irrespective of time, the total rate of complete cuff dehiscence in this cohort was 0.6% (n=13). Of the patients that developed a cuff dehiscence, at the 6 week exam all were noted to have an intact cuff, 9 patients were asymptomatic and 3 were symptomatic (vaginal bleeding n=1, pelvic pain n=2). One patient presented with dehiscence before her 6 week post-hysterectomy exam. Median time to cuff dehiscence was 106±5.6 weeks (range 5.1–119) for the cohort, 18.8±0.15 weeks (range 5.1–19.1) for benign hysterectomy, and 81.6±26.7 weeks (range 5.4–119) for oncologic hysterectomy. Patients with dehiscence following hysterectomy for benign indications presented with symptoms of pelvic pain and vaginal bleeding at the time of dehiscence, while those who had hysterectomy for oncologic indications were more likely to present with unprovoked dehiscence and without symptoms. Conclusion Performing a pelvic examination at the 6-week post-hysterectomy visit did not negate risk for future complete cuff dehiscence. Routine 6-week post-hysterectomy pelvic examinations in asymptomatic women may not be necessary.

The impact of cryotherapy for symptomatic cervical ectropion on female sexual function and quality of life

In rare cases, cervical ectropion causes symptoms such as abundant leucorrhoea, postcoital bleeding, recurrent cervicitis, pelvic pain, and dyspareunia. Cryotherapy is a commonly used treatment for symptomatic cervical ectropion. We assessed the impact of cryotherapy on sexual function and quality of life among patients with symptomatic cervical ectropion. In this prospective observational study, 73 patients were assessed before and six months after cryotherapy treatment using the Female Sexual Function Index (FSFI) and Short Form-12 Health Survey questionnaires. The double-freeze cryotherapy procedure was performed using a cryotherapy unit, and liquid nitrogen was used as a refrigerant. The mean physical and mental quality of life scores were significantly improved after treatment. With the exception of the pain domain, the overall and domain FSFI scores exhibited no significant differences before and after cryotherapy. The sexual pain domain scores were significantly increased after treatment. There was a statistically significant improvement in vaginal discharge, pelvic pain, and postcoital bleeding symptoms after the cryotherapy. We concluded that cryotherapy is an effective and feasible treatment for symptomatic cervical ectropion. Although cryotherapy results in improved quality of life scores, it has no significant impact on female sexual function. Impact statement What is already known on this subject? Cryotherapy is the most preferred treatment option for symptomatic cervical ectropion. Its feasibility and effectiveness with respect to symptom relief have been observed in previous studies. No study has evaluated quality of life and sexual function after cryotherapy among patients with symptomatic cervical ectropion. What do the results of this study add? Although the patients’ quality of life scores were significantly improved after treatment, no significant improvement was observed in overall and domain sexual function scores, with the exception of the pain domain. The sexual pain domain scores were significantly improved after cryotherapy. What are the implications of these findings for clinical practice and/or further research? Patients should not expect better sexual function after cryotherapy. Comparative studies should seek to identify the ideal treatment option, which would result in both symptom relief and better sexual function.

Prediction of Need for Morcellation during Total Laparoscopic Hysterectomy

Study Objective With all the concerns surrounding uterine morcellation, our objective was to identify predictors of the need for morcellation during total laparoscopic hysterectomy (TLH). Design A retrospective cohort study (Canadian Task Force classification II-2). Setting University Hospital Center. Patients or Participants Women undergoing a TLH for a benign gynecologic pathology form January 1st 2017 to January 31th 2019. Interventions All women underwent a TLH. If the uterus was to voluminous to be removed vaginally, surgeons favored in-bag morcellation by laparoscopy. Uterine weight (uterine length x maximum width x anteroposterior diameter x 0.52) and characteristics (number and volume of leiomyomas) were assessed prior to surgery by ultrasound or MRI in order to predict the need for morcellation. Measurements and Main Results A total of 252 women underwent a TLH during the two-year period. Women had a mean age of 46±7 (30–71) years old and the three main indications for surgery were abnormal uterine bleeding (77%), chronic pelvic pain (36%) and bulk symptoms (25%). Mean uterine weight was 325 (17-1572)±272 grams, with 11/252 (4%) uterus being >1000 grams and 71% of women had at least one leiomyoma. Among women with a uterine weight 500 grams, 49 (100%) required morcellation. In addition to the estimated uterine weight (≥ 250 versus Conclusion Uterine weight estimated by preoperative imaging as well as the size and number of leiomyomas are useful predictors of the need for morcellation.

Gynecologic Pathology Presenting As Urologic Symptoms: A Lesson on Pelvic Nerves

Study Objective Patients with underlying gynecologic pathology often present with a combination of seemingly unrelated and non-specific complaints such as pelvic pain, urinary frequency, urgency, and gastrointestinal symptoms. Thus, patients are often misdiagnosed and mismanaged. A thorough understanding of pelvic nerve anatomy is important in properly diagnosing and treating these patients. Design N/A Setting N/A Patients or Participants This video will highlight two patient cases which demonstrate how gynecologic pathology can present as urologic symptoms secondary to disease involvement of certain pelvic nerves. The first patient is a 32 year old female who struggled with urinary frequency, urgency, nocturia, and pelvic pain; all of which were secondary to endometriotic implants overlying the hypogastric nerve. The second patient is a 31 year old female who also presented with urinary urgency, nocturia, and pelvic pain which was secondary to a large broad ligament fibroid impinging the hypogastric nerve and causing mass effect on her bladder. Interventions The first patient underwent robotic assisted laparoscopic excision of endometriotic tissue. The second patient underwent robotic assisted laparoscopic myomectomy. Measurements and Main Results Each of these patients had pathology either directly compressing the pelvic nerves or causing chemical irritation to the nerves. Postoperatively, after removal of endometrial implants resulting in decreased nerve irritation, the first patient's pain and urinary symptoms improved. Likewise, in the second patient, when the fibroid was removed the compression of the surrounding pelvic nerves and bladder were relieved and the patients, symptoms subsequently resolved. Conclusion Understanding pelvic nerve anatomy is important in properly diagnosing and managing patients who do not present with conventional gynecologic symptoms. It is important to remember that with structural and biochemical irritation of these nerves, gynecologic pathology can present as urologic or even gastrointestinal symptoms. Proper diagnosis saves the patient from unnecessary testing and ineffective treatments.

Balneogynaecology in the 21st century: increasingly recommended primary and complementary treatment of chronic gynaecological diseases.

Balneo-gynaecological treatment methods include external bath hydrotherapy, sedentary baths and topical dressings/cataplasm, and internal (intravaginal or intrarectal use of peloids and mineral water). Hyperosmolar thermal spas have been very popular in the treatment of infertility due to the improvement of symptoms of chronic pelvic pain, endometriosis, chronic vascular and inflammatory pelvic diseases. Acute pelvic inflammatory syndrome is a contraindication for balneo-hydrotherapy while hyperthermal hydrotherapy is contraindicated in endometriosis and neurovegetative dystonia due to the stimulation of hyperemia, which worsens the clinical picture. Balneo-hydrotherapy is not recommended in metrorrhagia and malignancies. Balneogynaecological treatment certainly has its own primary but also complementary role in the treatment of chronic gynaecological diseases and is increasingly recommended today.

A Clinician's Guide to the Treatment of Endometriosis with Elagolix.

Pain associated with endometriosis is a considerable burden for women, permeating all aspects of their lives, from their ability to perform daily activities to their quality of life. Although there are many options for endometriosis-associated pain management, they are often limited by insufficient efficacy, inconvenient routes of administration, and/or intolerable side effects. Elagolix, a nonpeptide, small-molecule gonadotropin-releasing hormone (GnRH) receptor antagonist, is the first new oral therapy to be approved for the treatment of endometriosis-associated pain in the United States in more than a decade. Modulation of estradiol with elagolix is dose dependent and ranges from partial to full suppression. Clinical evidence has shown that elagolix at both approved doses (150 mg once daily and 200 mg twice daily) is effective for reducing symptoms of pelvic pain (dysmenorrhea, nonmenstrual pelvic pain, and dyspareunia), improving quality of life, and decreasing use of rescue analgesics (nonsteroidal anti-inflammatory drugs and/or opioids). The availability of two dosing options allows for individualization of treatment based on baseline clinical factors and response to therapy. Elagolix is well tolerated, with less pronounced hypoestrogenic effects compared with GnRH agonists. This review provides an overview of elagolix, highlighting currently available treatment options and the application of this new treatment for women with endometriosis-associated pain.

Dienogest treatment improves quality of life in women with endometriosis: A prospective cohort study

One of the chronic disabling illness affecting approximately 10% of women in midst of their reproductive period is Endometriosis. The treatment goal of endometriosis is to activate decidualization within the hormonally dependent ectopic endometrium and is regularly given to alleviate pain symptoms and reduce its recurrence among women.The aim of the study was to evaluate the effectiveness of dienogest in reducing pain and its influence on (QOL) quality of life among women affected with endometriosis.A prospective observational cohort study was conducted at Karpaga Vinayaga Institute of Medical Sciences and Research Centre including fifty patients with endometriosis treated with dienogest two mg per day for three months. We assessed the pelvic pain symptoms by visual analogue scale and (QOL)quality of life was determined by physical and mental index before and after 3 months of use of dienogest.To perform statistical analysis, we used paired t test.Women were on average 33.18 ± 4.43 years. The mean ±SD of VAS of 7.72 (0.73) in women with endometriosis was progressively decreased to 4.34(0.66) after 3 months of treatment with dienogest. The physical index score values increased significantly from 31.94 to 42.77 (p<0.001). The mental index increased from 35.07 to 45.86 (p<0.001). Adverse effects include breast discomfort, headache, depression, acne, hot flushes and weight gain.The results suggest that among women with endometriosis, dienogest has a relatively favorable safety profile and is well accepted in bettering the quality of life (QOL).

Per Rectal Magnetic Infra- Red Laser Therapy by Optical Probe and Its Effect on Pelvic Pain, Dysuria and Haemospermia of the Patients of Chronic Pelvic Pain Syndrome

Objective: To observe the improvement of the symptoms of pelvic pain, dysuria and haemospermia after treatment with magnetic infrared laser therapy in patients with chronic pelvic pain syndrome. Methods : This study was an observational study done on 30 male patients with pelvic pain and age range varied from 30 to 60 years. The study was conducted from 2009 to 2011 in a private medical center in Dhaka city . The MIL-therapy in use has a wave length of 904 nm and a frequency of 3000 Hz. The Laser beam reaches the prostate with a special optic probe. In this study the patients were examined per rectally by doing digital rectal examination with use of gloves and gel. At the beginning we used a “Laser Super Sonic” machine with endorectal probe according to Strada. The treatment schedule was one treatment every two days (treatment’s time of 5/10 minutes, wave length 1000 KHz)) for a total of 10 applications. After 10 applications patients were asked for follow-up and data were callected and analysed. Results : Out of 30 patients of chronic pelvic pain syndrome aged between 30-60 yrs with compains of pelvic pain, dysuria and haemospermia were under treatment with MIL therapy. 18 patients with pelvic pain, 13 patients with dysuria and 04 patients with haemospermia were cured after laser treatment . There were improvement of symptoms of pelvic pain in 11 patients, dysuria in 07 patients after laser therapy . But 01 patient found not improved . Among 30 cases 23 patients found normal sized prostate and 07 found enlarged prostate on digital rectal examination and on USG findings, 21 were found normal sized, 09 found enlarged sized prostate and 07 patients had increased PVR Conclusion : Patient sign and symptoms improved significantly after M/L therapy. Bangladesh Journal of Urology, Vol. 17, No. 1, Jan 2014 p.42-46

Clinically Meaningful Reduction in Dyspareunia Is Associated With Significant Improvements in Health-Related Quality of Life Among Women With Moderate to Severe Pain Associated With Endometriosis: A Pooled Analysis of Two Phase III Trials of Elagolix

BackgroundDyspareunia experienced by women diagnosed with endometriosis is associated with a decreased health-related quality of life (HRQoL). AimWe evaluated the relationship of clinically meaningful improvements in dyspareunia with HRQoL changes among women with endometriosis. MethodsThis was a post hoc analysis of pooled data from the phase III ELARIS-I and ELARIS-II clinical trials. Women aged 18–49 years with moderate to severe endometriosis-associated pain were randomized to placebo, elagolix 150 mg once daily, or elagolix 200 mg twice daily. HRQoL was measured using the validated Endometriosis Health Profile-30 questionnaire (EHP-30), consisting of 5 core domains and a sexual intercourse modular domain. Dyspareunia was ranked 0–3 (none, mild, moderate, or severe) or not applicable using a daily eDiary and averaged monthly. A woman with a clinically meaningful dyspareunia response (dyspareunia responder) was defined as a woman with a reduction from the baseline in dyspareunia score greater than or equal to a predetermined cutoff while maintaining stable/decreased analgesic use. OutcomesDyspareunia response impact on EHP-30 scores was determined at 3 and 6 months using multivariate linear regression controlling for age, baseline EHP-30 scores, and dysmenorrhea and non-menstrual pelvic pain symptom severity. ResultsAnalysis included 1,368 women with a mean age of 32.2 years. Dyspareunia responders had significant improvements vs non-responders in all adjusted mean EHP-30 domain scores at months 3 and 6 (control and powerlessness: −17.8 and −18.5; emotional well-being: −10.0 and −10.4; pain: −15.3 and −15.7; self-image: −11.4 and −12.8; social support: −14.3 and −14.0; and sexual intercourse: −18.1 and −19.7; all P < .0001). Clinical ImplicationsDyspareunia improvements are associated with both personal and psychological benefits. Strengths & LimitationsThis study involved a large sample of women from a well-defined patient population to provide statistical power in evaluating the results. As such, the findings may not be generalizable in a real-world setting. Although the perception of dyspareunia and its severity and the associated effect on HRQoL was subjective, the use of a large patient sample was used to minimize potential issues with this limitation. ConclusionClinically meaningful responses in dyspareunia are associated with improvements across multiple HRQoL domains among women with endometriosis.Agarwal SK, Soliman AM, Pokrzywinski RM, et al. Clinically Meaningful Reduction in Dyspareunia Is Associated with Significant Improvements in Health-Related Quality of Life Among Women with Moderate to Severe Pain Associated with Endometriosis: A Pooled Analysis of Two Phase III Trials of Elagolix. J Sex Med 2020;17:2427–2433.

The Prevalence of Endometriosis in Adolescents with Pelvic Pain: A Systematic Review.

Endometriosis is a recognized cause of pelvic pain in adolescents with menstrual symptoms that significantly affect education, activity, and social interactions. We aim to provide an updated systematic review of the prevalence of endometriosis in adolescents with pelvic pain presenting for gynecological investigation. We searched Medline, Embase, and Cinahl from 2011 to July2019. We included cohort studies of adolescents with pelvic pain undergoing gynecological investigation. Two authors independently selected studies and extracted study characteristics and prevalence data. Methodological quality was assessed using the Critical Appraisal Skills Program for cohort studies. This updated systematic review evaluated a total of 19 studies including 1243 symptomatic adolescents. In all, 648 of 1011 (64%) adolescents undergoing laparoscopy were found to have endometriosis. The prevalence ranged from 25% to 100%, with a mean prevalence of 64%. Thirteen studies including 381 participants categorized disease severity using the revised American Society of Reproductive Medicine classification. Among these, 53% of participants (201/381) had stage I, 28% (105/381) had stage II, 20% (76/381) had stage III, and 13% (49/381) had stage IV disease. The prevalence of endometriosis among adolescents with pelvic pain symptoms is high. Endometriosis is treatable, and prompt recognition will help to ensure that adolescents are signposted earlier to appropriate specialists. The management of adolescents with suspected endometriosis should be consistent with best practice guidance. Despite recommendations to increase the awareness and knowledge of endometriosis in adolescence, minimal research has followed.

Imperforate hymen: a rare cause of tenesmus

Imperforate hymen is an uncommon obstructive anomaly of the female reproductive tract for which early diagnosis is easy to miss. Untreated cases after menarche may cause cyclic lower abdominal pain and amenorrhea. Hymenotomy is considered proper management in order to avoid complications associated with late treatment. We report a case of an imperforate hymen in a 13-year-old adolescent girl presenting with tenesmus and acute lower abdominal pain. The patient was treated with hymenotomy and postoperative period was uneventful. Tenesmus and lower abdominal pain resolved immediately after surgery and during follow up the girl reported normal menstrual cycles. According to our case, tenesmus may be an atypical clinical presentation of imperforate hymen. Therefore, imperforate hymen should not be eliminated from differential diagnosis when it comes to adolescent females with abdominal pelvic pain and gastrointestinal symptoms and gynecological examination should be performed.

The Prevalence and Educational Impact of Pelvic and Menstrual Pain in Australia: A National Online Survey of 4202 Young Women Aged 13-25Years.

To explore the prevalence and impact of dysmenorrhea, pelvic pain and menstrual symptoms on young women at school or in tertiary education. Cross-sectional online survey in Australia. A total of 4202 adolescent and young women (13-25years of age; median age 17years), having reached menarche, living in Australia and currently attending school (n=2421) or tertiary education (n=1781). Online survey hosted by Qualtrics between November 2017 to January 2018. Data were collected on sociodemographic data, menstrual cycle characteristics, dysmenorrhea, pelvic pain, and educational and social impact. Information on menstrual and pelvic pain impact, academic absenteeism and presenteeism, impact on non-academic activities and interactions with teaching staff. Dysmenorrhea was reported by 92% of respondents. Dysmenorrhea was moderate (median 6.0 on a 0-10 numeric rating scale) and pain severity stayed relatively constant with age [rs(3804)=0.012, P=.477]. Noncyclical pelvic pain at least once a month was reported by 55%. Both absenteeism and presenteeism related to menstruation were common. Just under half of women reported missing at least one class/lecture in the previous three menstrual cycles. The majority of young women at school (77%) and in tertiary education (70%) reported problems with classroom concentration during menstruation. Higher menstrual pain scores were strongly correlated with increased absenteeism and reduced classroom performance at both school and in tertiary education. Despite the negative impact on academic performance the majority of young women at school (60%) or tertiary education (83%) would not speak to teaching staff about menstruation.

Neuronal/astrocytic expression of chemokine (C-C motif) ligand 2 is associated with monocyte/macrophage recruitment in male chronic pelvic pain.

Chronic pelvic pain syndrome is a multisymptom syndrome with unknown etiology. The experimental autoimmune prostatitis (EAP) mouse model of chronic pelvic pain syndrome is associated with immune cell infiltration into the prostate, expression of C-C chemokine ligand 2 (CCL2), and neuroinflammation in the spinal cord. Here, we studied CCL2 expression in tissues along the nociceptive pathway and its association with neuroimmune cells during pain development. Examination of prostate tissues at days 14 and 28 after EAP induction revealed CCL2 expression was increased in epithelial cells and was associated with increased numbers of macrophages lying in close apposition to PGP9.5-positive afferent neuronal fibers. C-C Chemokine ligand 2 immunoreactivity was elevated to a similar degree in the dorsal root ganglia at day 14 and day 28. D14 of EAP was associated with elevated IBA1 cells in the dorsal root ganglia that were not evident at D28. Adoptive transfer of green fluorescent protein+ leukocytes into EAP mice demonstrated monocytes are capable of infiltrating the spinal cord from peripheral blood with what seemed to be a proinflammatory phenotype. In the lower dorsal spinal cord, CCL2 expression localized to NeuN expressing neurons and GFAP-expressing astrocytes. Myeloid derived cell infiltration into the spinal cord in EAP was observed in the L6-S2 dorsal horn. Myeloid-derived CD45 IBA1+ cells were localized with IBA1+ TMEM199+ microglia in the dorsal horn of the spinal cord in EAP, with intimate association of the 2 cell types suggesting cell-cell interactions. Finally, intrathecal administration of liposomal clodronate ameliorated pelvic pain symptoms, suggesting a mechanistic role for macrophages and microglia in chronic pelvic pain.

A Preliminary Analysis of a Multidisciplinary Fibroid Clinic Patient Satisfaction and Demographics [10F

INTRODUCTION: Fibroids are benign growths of the uterine muscle that can cause a variety of symptoms including abnormal uterine bleeding, pelvic pain, and bulk symptoms. Our institution created a dedicated multidisciplinary Fibroid Program to address the needs of patients with symptomatic fibroids. Cases were reviewed with gynecologists, diagnostic radiologists, and interventional radiologists to provide tailored treatment plans and counseling for patients. METHODS: Patients seen between 1/2014 and 8/2018 (n=312) completed intake surveys detailing demographic background, prior treatments, most problematic symptoms, and a validated quality of life (UFS-QOL) survey. One-year follow up surveys about treatments, Likert scale rated satisfaction, and updated UFS-QOL were sent out to all patients and responses (n=111) were analyzed. Chart review clarifying fibroid size and locations was also performed. RESULTS: The average age of patients was 43.6 ± 0.4 years old. Upon initial presentation, 70.1% reported abnormal bleeding, 80.6% had pain, 44.3% had urinary symptoms, 77.4% had abdominal fullness, and 32.5% had bowel complaints. The average UFS-QOL score prior to treatment was 53.0 (out of 100). After treatment the average UFS-QOL score was 78.3, a difference of 25.3 points after being seen in the Fibroid Program. Patient reported satisfaction was excellent, with 79.2% of patients rating their satisfaction at 5 out of 5. CONCLUSION: Patients had a high rate of satisfaction after participation in our multidisciplinary Fibroid Program and UFS-QOL scores improved. We hope that this model can continue to be used to improve the life of patients by demonstrating the success of multidisciplinary informed counseling, tailored treatment, and shared-decision making.

Quality of Life Results After 52 Weeks of Treatment With Linzagolix for Endometriosis-Associated Pain [30B

INTRODUCTION: Linzagolix is a new investigational, non-peptide, oral GnRH receptor antagonist being developed to treat endometriosis-associated pain (EAP). The EDELWEISS trial was a Phase 2b, double-blind, randomized, placebo-controlled, multicenter, dose-ranging trial in USA and Europe evaluating once daily oral doses of 50, 75, 100 and 200 mg taken for up to 52 weeks. Subjects randomized to placebo were crossed over to 100 mg after 12 weeks and those randomized to 200 mg were crossed over to 100 mg after 24 weeks. METHODS: IRB approval was obtained. Participants were women with surgically confirmed endometriosis and moderate to severe EAP. Assessment of EAP included dyspareunia, non-menstrual pelvic pain, dyspareunia and dyschezia symptoms. Quality of life endpoints included the difficulty of doing daily activities, Patient Global Impression of Change/Severity (PGIC/S) and Endometriosis Health Profile-30 (EHP-30). RESULTS: 327 patients were randomized and treated. Mean age was 32 years and mean BMI was 26. In the treatment groups receiving linzagolix 75 mg and above there were significant improvements compared to placebo in EAP symptoms as well as the EHP-30 domain scores, PGIC and difficulty of doing daily activities at 12 weeks. These improvements were maintained or increased after 52 weeks of treatment. CONCLUSION: Linzagolix doses of 75 to 200 mg taken once daily for 52 weeks significantly decreased EAP and improved quality of life in women with moderate to severe endometriosis-associated pain.

Correlates of 1-Year Change in Quality of Life in Patients with Urologic Chronic Pelvic Pain Syndrome: Findings from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network.

We evaluated and identified baseline factors associated with change in health related quality of life among patients with interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome. A total of 191 men and 233 women with interstitial cystitis/bladder pain syndrome or chronic prostatitis/chronic pelvic pain syndrome (collectively referred to as urologic chronic pelvic pain syndrome) were followed for 12 months with bimonthly completion of the Short Form 12 to assess general mental and physical health related quality of life, and with biweekly assessment of condition specific health related quality of life using the Genitourinary Pain Index. A functional clustering algorithm was used to classify participants as improved, stable or worsened for each health related quality of life measure. Ordinal logistic regression was used to determine baseline factors associated with change. Physical health related quality of life improved in 22% of the participants, mental health related quality of life improved in 25% and condition specific health related quality of life improved in 47%. Better baseline physical health related quality of life, older age and the presence of nonurological symptoms were associated with lower likelihood of improvement in physical health related quality of life. Better baseline mental health related quality of life, female sex, and greater baseline depression and stress were associated with a lower likelihood of improvement in mental health related quality of life. Better baseline condition specific health related quality of life and more severe baseline urologic chronic pelvic pain syndrome pain symptoms were associated with a lower likelihood of improvement in condition specific health related quality of life. While several nonurologic chronic pelvic pain syndrome factors influenced the trajectory of general health related quality of life over time, only condition specific baseline health related quality of life and urologic chronic pelvic pain syndrome symptoms were associated with urologic chronic pelvic pain syndrome specific health related quality of life change. Significant differences in how urologic chronic pelvic pain syndrome impacts various aspects of health related quality of life suggest a multidisciplinary approach to assessment and treatment of these patients.

MP48-01 PHARMACOGENETIC INHIBITION OF LUMBOSACRAL SPINAL AND SENSORY NEURONS ALLEVIATES VISCERAL PAIN AND IMPROVES LOWER URINARY TRACT SYMPTOMS IN ANIMAL MODEL OF UROLOGICAL CHRONIC PELVIC PAIN SYNDROME

INTRODUCTION AND OBJECTIVE:Patients with urological chronic pelvic pain syndrome (UCPPS) experience chronic pelvic pain (CPP) and lower urinary tract symptoms (LUTS). Previous studies showed that a...

MP54-06 PANNEXIN 1 CHANNELS INVOLVEMENT IN MECHANISM OF STRESS-INDUCED PELVIC PAIN AND URINARY SYMPTOMS IN MICE

INTRODUCTION AND OBJECTIVE: Pannexin 1 (Panx1) channels are key components of the urothelial mechanosensory and mechanotransduction system. They are mechanosensitive and provide a direct conduit for urothelial ATP release in response to bladder distension. Little is known of the role of Panx1 channels in bladder pathology. The goal of this study is to evaluate if Panx1 channels are involved in emergence of pelvic pain and urinary symptoms in an animal model of stress. METHODS: Wildtype (WT) and Panx1-null mice, and the stress model of 96 hours of continuous illumination (CI) were used in this study. Pelvic tactile sensitivity and bladder function were evaluated at baseline (pre-CI) and the day after the 96 hours of CI using the Von Frey test and the void stain on paper (VSOP) method, respectively. ATP levels in spontaneously voided urine were quantified pre- and post-CI using the luciferin-luciferase assay. Bladders were harvested from CI stressed and age-matched controls (housed under conventional 12 hour/day illumination), and urothelial Panx1 mRNA levels were quantified by real time PCR. Cystometric data from an additional group of WT mice was obtained pre-CI and then post-CI with and without intravesical treatment with Panx1 channel blocker mefloquine (300nM). Data is expressed as mean±SEM and statistical difference determined by paired or unpaired Student’s t-test. RESULTS: In WT mice, pelvic tactile threshold decreased 18-fold (pre-CI: 0.22 ± 0.06 vs post-CI: 0.012 ± 0.007; N = 4 p<0.01) and voiding frequency increased 2-fold (pre-CI: 0.56 ± 0.04 vs post-CI: 1.11 ± 0.12; N = 4 p<0.01) after CI. This was accompanied by a 2.5-fold increase in Panx1 expression in the bladder urothelium when compared to non-stressed WT mice (2.53 ± 0.29 stressed/non-stressed controls; N=4; p<0.001), and a 2-fold increase in urothelial ATP release compared to baseline levels (1.8 ± 0.24 post-CI/pre-CI; N = 4; p=0.007). Notably, emergence of pelvic pain and voiding frequency was abrogated in Panx1-null mice submitted to CI stress, and urothelial ATP release was not different from control pre-CI levels. Urodynamic assessment of WT mice after CI indicated marked bladder hyperactivity that was normalized by intravesical treatment with Panx1 channel blocker mefloquine. CONCLUSIONS: Panx1 channels play a significant role in stress-induced pelvic pain and urinary frequency, likely by amplifying urothelial ATP release that can ultimately change the bladder sensory and motor responses, and cause bladder sensitization. Source of Funding: None

First-trimester intrauterine hematoma and pregnancy complications.

To assess whether sonographic diagnosis of intrauterine hematoma (IUH) in the first trimester of pregnancy is associated with first-trimester miscarriage and antenatal, delivery and neonatal complications. This was a prospective observational cohort study of women with an intrauterine singleton pregnancy between 5 and 14 weeks' gestation recruited at Queen Charlotte's and Chelsea Hospital, London, UK, between March 2014 and March 2016. Participants underwent serial ultrasound examinations in the first trimester, and the presence, location, size and persistence of any IUH was evaluated. First-trimester miscarriage was defined as pregnancy loss before 14 weeks' gestation. Clinical symptoms, including pelvic pain and vaginal bleeding, were recorded at each visit using validated symptom scores. Antenatal, delivery and neonatal outcomes were obtained from hospital records. Logistic regression analysis and the chi-square test were used to assess the association between the presence and features of IUH and the incidence of adverse pregnancy outcome. Odds ratios (OR) were first adjusted for maternal age (aOR) and then further adjusted for the presence of vaginal bleeding or pelvic pain in the first trimester. Of 1003 women recruited to the study, 946 were included in the final analysis and of these, 268 (28.3%) were diagnosed with an IUH in the first trimester. The presence of IUH was associated with the incidence of preterm birth (aOR, 1.94 (95% CI, 1.07-3.52)), but no other individual or overall antenatal, delivery or neonatal complications. No association was found between the presence of IUH in the first trimester and first-trimester miscarriage (aOR, 0.81 (95% CI, 0.44-1.50)). These findings were independent of the absolute size of the hematoma and the presence of vaginal bleeding or pelvic pain in the first trimester. When IUH was present in the first trimester, there was no association between its size, content or position in relation to the gestational sac and overall antenatal, delivery and neonatal complications. Diagnosis of a retroplacental IUH was associated with an increased risk of overall antenatal complications (P = 0.04). Our findings demonstrate that there is no association between the presence of IUH in the first trimester and first-trimester miscarriage. However, an association with preterm birth, independently of the presence of symptoms of pelvic pain and/or vaginal bleeding, is evident. Women diagnosed with IUH in the first trimester should be counseled about their increased risk of preterm birth and possibly be offered increased surveillance during the course of their pregnancy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Addressing heterogenous outcomes in uterine fibroid research: a call to action

Uterine fibroid tumors are the most common benign pelvic tumors in women, with complications that include heavy menstrual bleeding, pelvic pain, reproductive complications, and bulk-related symptoms. Although the majority of uterine fibroid tumors are asymptomatic, those women who experience symptoms can experience substantial burdens on quality of life and daily functioning. Comparative effectiveness reviews of available medical, surgical, and radiologic treatments have found that a lack of high-quality data to inform treatment decisions is, in part, due to the use of heterogeneous outcomes and instruments in clinical studies. With multiple new interventions emerging, this call-to-action encourages the development and use of a core outcome set that will capture the most relevant, patient-important outcomes in late-phase and after-marketing therapeutic trials for uterine fibroid tumors. The core outcome set should be developed by a diverse, multistakeholder group comprised of key healthcare decision-makers. Development and uptake of a core outcome set ensures that a consistent, collaboratively vetted set of outcomes will be accessible across different studies and promotes transparency for innovators who seek to anticipate the evidence needs of patients, providers, payers, regulators, and other stakeholders.