Recognition and treatment of endometriosis involving the sacral nerve roots

Lemos N, Nucelio Lemos, Nicolau D'Amico, D'Amico N, Marques R, Renato Moretti‐Marques, Renato Marques, Kamergorodsky G, Gil Kamergorodsky, Schor E, Eduardo Schor, Manoel João Batista Castelo Girão, Manoel J B C Girão, Girão Mj
International urogynecology journal · 2015 · vol. 27(1) , pp. 147–150 · doi:10.1007/s00192-015-2703-z · PMID:25910611 · W1963934982
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This video explains laparoscopic treatment for sacral plexus endometriosis, showing a significant reduction in pain and improvement in symptoms in 13 patients.

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Abstract

Introduction and hypothesisEndometriosis involving the sacral plexus is still poorly understood or neglected by many surgeons. Looking at that scenario, we have designed this educational video to explain and describe the symptoms suggestive of endometriotic involvement of the sacral plexus in addition to the technique for the laparoscopic treatment of this condition.MethodsRetrospective analysis of 13 consecutive cases of endometriotic entrapment of nerves of the lumbosacral plexus.ResultsPaired t test revealed a statistically significant (p < 0.0000001) reduction in pain VAS score, from preoperative average 9.1 (±1.98) to postoperative 1.46 (±1.66). Twelve out of 13 patients (92.3%) experienced a reduction of 50% or more in VAS score and 6 (46.15%) became completely pain-free.ConclusionThe signs suggestive of intrapelvic nerve involvement include perineal pain or pain irradiating to the lower limbs, lower urinary tract symptoms, tenesmus or dyschezia associated with gluteal pain. Whenever deeply infiltrating lesions are present, the patient must be asked about those symptoms and specific MRI sequences for the sacral plexus must be taken, so that the equipment and team can be arranged and proper treatment performed.
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Abstract

Introduction and hypothesis Endometriosis involving the sacral plexus is still poorly understood or neglected by many surgeons. Looking at that scenario, we have designed this educational video to explain and describe the symptoms suggestive of endometriotic involvement of the sacral plexus in addition to the technique for the laparoscopic treatment of this condition.

Methods

Retrospective analysis of 13 consecutive cases of endometriotic entrapment of nerves of the lumbosacral plexus.

Results

Paired t test revealed a statistically significant (p < 0.0000001) reduction in pain VAS score, from preoperative average 9.1 (±1.98) to postoperative 1.46 (±1.66). Twelve out of 13 patients (92.3 %) experienced a reduction of 50 % or more in VAS score and 6 (46.15 %) became completely pain-free.

Conclusion

The signs suggestive of intrapelvic nerve involvement include perineal pain or pain irradiating to the lower limbs, lower urinary tract symptoms, tenesmus or dyschezia associated with gluteal pain. Whenever deeply infiltrating lesions are present, the patient must be asked about those symptoms and specific MRI sequences for the sacral plexus must be taken, so that the equipment and team can be arranged and proper treatment performed.

References

DENTON RO, SHERRILL JD. Sciatic syndrome due to endometriosis of sciatic nerve. South Med J. 1955 Oct;48(10):1027-31. Possover M, Schneider T, Henle KP (2011) Laparoscopic therapy for endometriosis and vascular entrapment of sacral plexus. Fertil Steril 95(2):756–758 Russel SM (2006) Examination of peripheral nerve injuries. Thieme, New York Possover M, Lemos N (2011) Risks, symptoms, and management of pelvic nerve damage secondary to surgery for pelvic organ prolapse: a report of 95 cases. Int Urogynecol J 22(12):1485–1490 Lemos N, Kamergorodsky G, Ploger C, Castro R, Schor E, Girão M (2012) Sacral nerve infiltrative endometriosis presenting as perimenstrual right-sided sciatica and bladder atonia: case report and description of surgical technique. J Minim Invasive Gynecol 19(3):396–400 Consent Written informed consent was obtained from the patient for publication of this video article and any accompanying images. Conflict of interest Nucelio Lemos receives research grants from Medtronic Inc. and Laborie Inc. and proctorship grants from Medtronic Inc. None of these grants is, however, directly related to the current publication. Eduardo Schor receives research grants from Abbott Inc. and Libbs Inc. and speaker/proctor grants from AstraZeneca Inc. None of these grants is directly related to the current publication. None of the other co-authors has anything to disclose. Authors’ contributions N. Lemos: project development, data collection, manuscript writing; N. D’Amico: project development, data collection; R.M. Marques: project development, data collection; G. Kamergorodsky: data collection; E. Schor: project development, data collection; M.J.B.C. Girão: project development, manuscript writing. Author information Authors and Affiliations Corresponding author Electronic supplementary material Below is the link to the electronic supplementary material. (MP4 86541 kb) Rights and permissions About this article Cite this article Lemos, N., D’Amico, N., Marques, R. et al. Recognition and treatment of endometriosis involving the sacral nerve roots. Int Urogynecol J 27, 147–150 (2016). https://doi.org/10.1007/s00192-015-2703-z Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00192-015-2703-z

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Endometriosis Female Urogenital Diseases Lumbosacral Plexus Nerve Compression Syndromes Spinal Nerve Roots Adult Endometriosis Endometriosis Endometriosis Female Female Urogenital Diseases Humans Laparoscopy Nerve Compression Syndromes Nerve Compression Syndromes Nerve Compression Syndromes Pelvic Pain Retrospective Studies

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