Relating Pelvic Pain Location to Surgical Findings of Endometriosis

George Washington University, Washington, Washington, D.C., United States
Obstetrics and Gynecology (Impact Factor: 4.37). 08/2011; 118(2 Pt 1):223-30. DOI: 10.1097/AOG.0b013e318223fed0
Source: PubMed

ABSTRACT To study whether pain location is related to lesion location in women with chronic pelvic pain and biopsy-proven endometriosis.
A secondary analysis was performed to compare self-reported pain location with recorded laparoscopy findings for location and characteristics of all visible lesions. All lesions were excised. Endometriosis was diagnosed using histopathology criteria. The pelvic area was divided into three anterior and two posterior regions. Lesion depth, number of lesions or endometriomas, and disease burden (defined as sum of lesion sizes, or single compared with multiple lesions) were determined for each region. Data were analyzed using t tests, Fisher exact tests, and logistic regression modeling, with P values corrected for multiple comparisons using the step-down Bonferroni method.
Women with endometriosis (n = 96) had lower body mass indexes, were more likely to be white, had more previous surgeries, and had more frequent menstrual pain and incapacitation than did chronic pain patients without endometriosis (n = 37). Overall, few patients had deeply infiltrating lesions (n = 38). Dysuria was associated with superficial bladder peritoneal lesions. Other lesions or endometriomas were not associated with pain in the same anatomic locations. Lesion depth, disease burden, and number of lesions or endometriomas were not associated with pain.
In this group of women with biopsy-proven endometriosis, few had deeply infiltrating lesions or endometriomas. Dysuria and midline anterior pain were the only symptoms associated with the location of superficial endometriosis lesions. The lack of relationship between pain and superficial lesion location raises questions about how these lesions relate to pain.,, NCT00001848.
: II.


Available from: James H Segars, Aug 21, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Endometriosis is a chronic disease affecting mainly women of the reproductive age. Its most common manifesta-tions include impaired fecundity, pelvic pain, and dyschezia. Laparoscopic removal of endometriotic foci remains to be the gold standard for the treatment of endometriosis. More effec-tive techniques of endoscopic approach—among others, laser application—are continually being developed. The aim of the study was to evaluate the efficacy of laparoscopic treatment with the use of CO 2 laser ablation vs. electroablation with regard to pain complaints in the affected patients. The study included 48 women (aged 22–42) with varying degrees of endometriosis of the lesser pelvis. The Numeric Rating Scale (NRS) was used to evaluate pain intensity before the surgery in all patients, followed by either laser ablation or electroablation of the endometriotic foci. The results of the laparoscopic treatment were monitored after 3 and 6 months postoperatively. p value of 0.05 was considered to be statisti-cally significant. Patients from both groups reported less in-tensive pain before/during menstruation (dysmenorrhea) 6 months postoperatively, with more distinct tendency in the electroablation group (p=0.004) as compared to the laser ablation group (p=0.025). Despite the initial improvement reported at the 3-month checkup (p=0.008), 6 months post-operatively, a statistically significant increase in pain intensity was noted in both groups (p=0.016 and p=0.032 for CO 2 laser ablation and electroablation, respectively). Both surgical methods seem to be effective only in the treatment of endometriosis-related dysmenorrhea, whereas the intensity of other pain complaints (dyspareunia, dysuria, dyschezia, pelvic pain syndrome (PPS)) has remained on the same level.
    Lasers in Medical Science 07/2014; 30(1). DOI:10.1007/s10103-014-1630-4 · 2.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives To determine the correlation between historical variables at presentation with the phenotype and location of biopsy proven endometriosis at laparoscopy. Methods Prospective observational study. Consecutive women had laparoscopic surgery following clinical suspicion of endometriosis. Standardised history and clinical examination were taken, and the presenting complaints were evaluated within four subsets of women: (i) primary laparoscopy for endometriosis (ii) previous laparoscopically confirmed endometriosis (iii) biopsy positive for endometriosis and (iv) all biopsies negative for endometriosis. Historical pain variables within the four subsets were compared with disease location and phenotype (superficial, deep infiltrating, endometriomata) at laparoscopy. A stringent P-value of 0.01 was used as the cut-off for significance. ResultsOverall 104 consecutive women were included: mean age 34.3years, 66/104 (63.5%) had reoperation and 38/104 (36.5%) had primary laparoscopy. 89/104 (85.6%) were biopsy positive for endometriosis, and 11/104 (10.6%) were biopsy negative. Superficial endometriosis was most common phenotype. Site of pain did not correlate with ipsilateral location of disease. Significant correlations included as follows: dyspareunia and endometrioma (P=0.0009) in women undergoing reoperation; dyspareunia and posterior compartment (P=0.0086) and lateral compartment (P=0.0004) disease in women with histology proven endometriosis; left iliac fossa pain and biopsy proven posterior compartment endometriosis (P=0.0041). Conclusions Although a history of dyspareunia in women with previous endometriosis was significantly correlated with endometrioma, site-specific locations of pain symptoms did not correlate with ipsilateral locations of endometriosis at laparoscopy. The phenotype - combined deep and superficial endometriosis - was associated with dyspareunia among women with previous history of endometriosis.
    Australian and New Zealand Journal of Obstetrics and Gynaecology 10/2014; 54(5). DOI:10.1111/ajo.12256 · 1.62 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: As opposed to the satisfying solutions found in the management of acute pain, chronic pelvic pain can be a vexing problem for the patient and physician. Seldom is a single source or cause found, and nearly always the condition is influenced by the broader social and psychological context of the patient. In this article, we discuss the evaluation of chronic pelvic pain, often considering pain as the disease itself, and identify peripheral generators, which gynecologists can address to help reduce their contributions to symptoms.
    Obstetrics and Gynecology 09/2014; 124(3):616-629. DOI:10.1097/AOG.0000000000000417 · 4.37 Impact Factor