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Recognition and treatment of endometriosis involving the sacral nerve roots

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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.

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References

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    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

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    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

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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

Correspondence to Nucelio Lemos.

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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

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Keywords

  • Deeply infiltrating endometriosis
  • Laparoscopy
  • Lumbosacral plexus
  • Urinary symptoms
  • Sciatica
  • Pudendal pain