Aim of the video / Introduction
Pelvic congestion syndrome is a well-known cause of cyclic pelvic pain (Ganeshan et al., Cardiovasc Intervent Radiol 30(6):1105–11, 2007). What is much less well known is that dilated or malformed branches of the internal or external iliac vessels can entrap the nerves of the sacral plexus against the pelvic sidewalls, producing symptoms that are not commonly seen in gynecological practice, such as sciatica, or refractory urinary and anorectal dysfunction (Possover et al., Fertil Steril 95(2):756–8. 2011). The objective of this video is to explain and describe the symptoms suggestive of vascular entrapment of the sacral plexus, as well as the technique for the laparoscopic decompression of these nerves.
Two anecdotal cases of intrapelvic vascular entrapment are used to review the anatomy of the lumbosacral plexus and demonstrate the laparoscopic surgical technique for decompression at two different sites, one on the sciatic nerve and one on the sacral nerve roots.
After surgery, the patient with the sciatic entrapment showed full recovery of the sciatica and partial recovery of the myofascial pain. The patient with sacral nerve root entrapment showed full recovery with resolution of symptoms.
The symptoms suggestive of intrapelvic nerve entrapment are: perineal pain or pain irradiating to the lower limbs in the absence of a spinal disorder, and lower urinary tract symptoms in the absence of prolapse of a bladder lesion. In the presence of such symptoms, the radiologist should provide specific MRI sequences of the intrapelvic portion of the sacral plexus and a team and equipment to expose and decompress the sacral nerves should be prepared.
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Magnetic resonance imaging
Ganeshan A, Upponi S, Hon LQ, Uthappa MC, Warakaulle DR, Uberoi R (2007) Chronic pelvic pain due to pelvic congestion syndrome: the role of diagnostic and interventional radiology. Cardiovasc Intervent Radiol 30(6):1105–1111
Possover M, Schneider T, Henle KP (2011) Laparoscopic therapy for endometriosis and vascular entrapment of sacral plexus. Fertil Steril 95(2):756–758
Lemos N, Possover M (2015) Laparoscopic approach tin intrapelvic nerve entrapments. J Hip Preserv Surg. doi:10.1093/jhps/hnv030
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. doi:10.1007/s00192-011-1539-4
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. doi:10.1016/j.jmig.2012.02.001
Both patients provided signed written informed consent before each procedure was performed and authorized the use of all images and data relating to their case for scientific purposes.
Conflicts of interest
Nucelio Lemos received 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, however, related to the current publication.
None of the other co-authors has anything to disclose.
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Cite this article
Lemos, N., Marques, R.M., Kamergorodsky, G. et al. Vascular entrapment of the sciatic plexus causing catamenial sciatica and urinary symptoms. Int Urogynecol J 27, 317–319 (2016). https://doi.org/10.1007/s00192-015-2777-7
- Pelvic congestion syndrome
- Urinary incontinence
- Nerve entrapment syndrome