Laparoscopic uterine nerve ablation versus vaginal uterosacral ligament resection in postmenopausal women with intractable midline chronic pelvic pain: A randomized study

Stefano Palomba, Tiziana Russo, Angela Falbo, Francesco Manguso, Pietro D’Alessandro, Alberto Mattei, Achille Tolino, F Branconi, Errico Zupi, Fulvio Zullo
In: European Journal of Obstetrics & Gynecology and Reproductive Biology · 2006 · vol. 129(1) , pp. 84–91 · doi:10.1016/j.ejogrb.2005.12.007 · PMID:16442203 · W2114362262
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This randomized study compared laparoscopic uterine nerve ablation with vaginal uterosacral ligament resection in postmenopausal women with intractable midline chronic pelvic pain.

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Abstract

ObjectiveTo assess and compare the laparoscopic uterine nerve ablation (LUNA) and the vaginal uterosacral ligament resection (VUSR) in postmenopausal women with chronic pelvic pain (CPP).Study designEighty postmenopausal women with intractable and severe midline CPP were randomized to undergo LUNA or VUSR. Costs of two surgical procedures were assesses. Cure rate, severity of CPP, and deep dyspareunia were also evaluated after 6 and 12 months from surgery.ResultsThe mean cost of LUNA resulted significantly higher in comparison with VURS (2078+/-637 versus 1497+/-297, P<0.001). The cure rate was not significantly different between the two groups at 6 (33/40, 82.5% versus 35/40, 87.5% for groups A and B, respectively; P=0.530; RR 0.94, 95% CI 0.78-1.13), and 12 months (27/36, 75.0% versus 28/38, 73.7%, for groups A and B, respectively; P=0.901; RR 0.90, 95% CI 0.78-1.33) of follow-up. At same times, a significant (P<0.01) decrease in severity of CPP and deep dyspareunia was observed in both groups with no difference between them.ConclusionsBoth LUNA and VUSR are equally effective surgical treatments in postmenopausal women with central CPP but VUNR is significantly cheaper than LUNA.

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