Chronic pelvic pain syndromes--traditional and novel therapies: part I surgical therapy.

PURPOSE: To describe the role of various surgical therapies for the relief of pelvic pain. METHODS: The latest studies involving surgical therapies for relief of pelvic pain are reviewed and the pros and cons are discussed. RESULTS: Laparoscopic removal of endometriotic implants should be performed if the surgical procedure is being performed for diagnostic purposes. Laparoscopic utersacral nerve ablation of endometriotic implants and presacral neurectomy may provide additional relief but require greater surgical skills and have significant risks, especially bleeding. There still is a role for complete hysterectomy usually with bilateral salpingo-oophorectomy. CONCLUSIONS: Recurrence rates following surgery relegate surgical procedures behind medical therapy, i.e., to be used only if medical therapy is failing. Not all pelvic pain is related to endometriosis. Some novel concepts as to common mechanisms involved in a large percentage of these pelvic pain syndromes leading to some novel highly effective medical therapies will be discussed in part II.