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Effect of investigative laparoscopy on bladder pain syndrome: a prospective cohort trial

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Abstract

Introduction and hypothesis

Chronic pelvic pain is a debilitating condition, and establishing both an etiology and a successful management plan is challenging. Bladder pain syndrome (BPS) is one such etiology, with some studies reporting a prevalence of up to 50% in women with chronic pelvic pain (Van De Merwe et al. Eur Urol 53: 60–67, 2008; Cervigni and Natale Int J Urol 21: 85–88, 2014). This study aimed to assess the impact that investigative laparoscopy with treatment of endometriosis has on bladder pain syndrome in women with and without endometriosis.

Methods

A prospective cohort study was conducted with participants recruited from a tertiary gynecology unit and the private rooms of participating gynecologists. Women included were those scheduled for laparoscopy for investigation of pelvic pain of > 6 months, aged 18–40 years. Each patient completed a preoperative questionnaire, and a standardized study operative report was used to collect laparoscopy findings. Any endometriosis found was treated with excisional surgery. Patients were then reviewed with the same questionnaire at 3, 6 and 12 months post-surgery.

Results

A total of 150 patients were included in the trial. Seventy-five percent of patients (n = 112/150) were diagnosed with endometriosis. Of them, 43% (n = 48/112) also had BPS. The overall BPS rate was 43% (n = 64/150). At 12 months, there was a significant reduction in overall pain and pelvic pain in all groups. Of the women with BPS, there was no difference in symptom score reduction between those with endometriosis treated and those without endometriosis. BPS resolved in 42% of women 12 months post-laparoscopy, regardless of whether endometriosis was diagnosed and treated or not. Of the women without BPS preoperatively, 14% developed de novo BPS at 12 months, regardless of whether endometriosis was diagnosed and treated or not.

Conclusion

Our findings show that BPS improves in the 12 months after investigative laparoscopy and treatment of endometriosis for chronic pelvic pain, regardless of presence or absence of endometriosis.

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Acknowledgements

Thank you to the medical staff of the Gynecology 2 Unit of the Royal Women’s Hospital, Melbourne, for their contribution of time to data collection and to the Australasian Gynecological Endoscopy and Surgery Society for the research grant supporting this project.

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Authors and Affiliations

  1. The Royal Women’s Hospital, Locked Bag 300, Grattan St & Flemington Road, Melbourne, Victoria, 3052, Australia

    Rachel Collings, Martin Healey, Uri Dior, Romany Erwin & Claudia Cheng

  2. Department of Obstetrics & Gynecology, University of Melbourne, Melbourne, Australia

    Martin Healey & Claudia Cheng

  3. Monash Medical Centre, Melbourne, Australia

    Anna Rosamilia

Authors
  1. Rachel Collings
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  2. Martin Healey
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  3. Uri Dior
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  4. Romany Erwin
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  5. Anna Rosamilia
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  6. Claudia Cheng
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Correspondence to Rachel Collings.

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This study received a 2016 Australasian Gynecological Endoscopy and Surgery Society (AGES) research grant.

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Collings, R., Healey, M., Dior, U. et al. Effect of investigative laparoscopy on bladder pain syndrome: a prospective cohort trial. Int Urogynecol J 31, 1583–1591 (2020). https://doi.org/10.1007/s00192-019-04023-7

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  • DOI: https://doi.org/10.1007/s00192-019-04023-7

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