The Evil Twins of Chronic Pelvic Pain Syndrome:

Objective: To determine the value in the initial laparo-scopic and cystoscopic evaluation of avoiding the unnec-essary delay in diagnosing the “evil twins ” of chronic pelvic pain syndrome, endometriosis and interstitial cys-titis. Methods: We performed a retrospective review of 60 women ranging in age from 19 to 62. They underwent concurrent laparoscopy, cystoscopy, and hydrodisten-tions from January 1999 to October 2000. A gynecology and urology team performed these procedures in these 60 patients at a regional pelvic pain center in Northwest Ohio. Results: Fifty-eight patients (96.6%) were diagnosed with interstitial cystitis by the presence of glomerulation and terminal hematuria according to National Institutes of Health criteria. A diagnosis of (active and inactive) endometriosis was found in 56 patients (93.3%). Biopsy-confirmed active endometriosis was found in 48 patients (80%). In the interstitial cystitis patient group (58), 54 patients had a diagnosis of (active and inactive) endometriosis (93.1%), and 47 patients had biopsy-con-firmed active endometriosis (81%). In the group of 56 patients with a diagnosis of (active and inactive) endometriosis, 54 patients were found to have interstitial cystitis (96.4%). In the group of 48 patients with active biopsy-confirmed endometriosis, 47 have interstitial cys-titis (97.7%). Conclusion: Patients with chronic pelvic pain syndrome are very difficult to manage. Eighty percent were found to have endometriosis and had numerous previous oper-ations. Many patients failed to respond to multiple ther-apies. In many cases, pain persists even after a hysterec-