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
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.
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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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DOI: https://doi.org/10.1007/s00192-015-2703-z