Histopathologic findings on uterosacral ligaments in women with chronic pelvic pain and visually normal pelvis at laparoscopy

Patricia Nascu, Patricia C Nascu, Nascu PC, Vilos GA, George A Vilos, Hellen C Ettler, Ettler HC, Abu-Rafea B, Basim Abu-Rafea, Basim Abu‐Rafea, Jackie Hollet-Caines, Hollet-Caines J, Riad Ahmad, Ahmad R
Journal of Minimally Invasive Gynecology · 2006 · vol. 13(3) , pp. 201–204 · doi:10.1016/j.jmig.2006.02.002 · PMID:16698525 · W2135273231
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This study examined uterosacral ligament histopathology in women with chronic pelvic pain and a visually normal pelvis at laparoscopy to identify underlying microscopic abnormalities.

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Abstract

Study objectiveTo determine the prevalence and type of microscopic findings on laparoscopically resected uterosacral ligaments in women with chronic pelvic pain and no visible pelvic disease. The effect of this procedure on the patients' level of pain also was assessed as a secondary objective.DesignProspective follow-up (Canadian Task Force classification II-2).SettingUniversity-affiliated hospital.PatientsTwenty-seven premenopausal women undergoing diagnostic laparoscopy for chronic pelvic pain had a normal pelvis on visual inspection. All patients underwent resection and histologic evaluation of the uterosacral ligaments. Pain relief was evaluated by use of a questionnaire administered before and at 3, 6, and 12 months after surgery.Measurements and main resultsMicroscopic examination identified endometriosis in 2 (7.4%), endosalpingiosis in 3 (11.1%), and inflammation in 14 (51.9%) patients. Laparoscopic uterosacral ligament resection was associated with a reduction in dysmenorrhea (p < or = .001), with 14 (52%) patients reporting improved or resolved symptoms. There was a statistically significant decrease in dyspareunia (p < or = .01) and in the severity of noncyclical pain (p < or = .002). Thirty-five percent of patients no longer required medication for pain control (p < or = .005). The number of days needed off work also decreased.ConclusionDespite normal laparoscopic appearance, microscopic endometriosis, endosalpingiosis, and inflammatory changes were found in uterosacral ligaments in 17 (63%) women with chronic pelvic pain. Laparoscopic resection of uterosacral ligaments improved dysmenorrhea, dyspareunia, and noncyclical pain and decreased the number of days lost from work, as well as the proportion of patients who required medication for pain control.

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Condition tags

chronic_pelvic_pain

MeSH descriptors

Adnexa Uteri Ligaments Pelvic Pain Pelvic Pain Adnexa Uteri Adnexa Uteri Adolescent Adult Chronic Disease Female Follow-Up Studies Gynecologic Surgical Procedures Hospitals, University Humans Laparoscopy Ligaments Ligaments Pelvic Pain Prospective Studies Treatment Outcome

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