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Syndrome douloureux pelvien chronique de l’adénomyose utérine: critères diagnostiques et traitement conservateur

Chronic pelvic pain syndrome due to uterine adenomyosis: diagnostic criteria and conservative treatment

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Pelvi-périnéologie

Résumé

Introduction|

L’adénomyose est une cause fréquente de douleur pelvienne chronique chez la femme. De 2001 à 2008, chez 270 patientes, ce syndrome de douleur pelvienne chronique a été rattaché à une adénomyose utérine par l’utilisation de critères et d’un score diagnostique. L’étude rétrospective de 246 dossiers a permis de valider ces critères diagnostiques avec une sensibilité de 98 % et une spécificité de 90 %.

Discussion|

L’hystérectomie, lorsqu’elle est réalisée dans cette étude, apporte alors jusqu’à 91 % d’améliorations significatives (AS) sur le syndrome douloureux pelvien et 81 % de guérisons complètes, résultats largement supérieurs à ceux obtenus lorsque l’hystérectomie est proposée dans la douleur pelvi-périnéale en général. Les 9 % d’échecs pouvant être rattachés aux phénomènes d’hypersensibilité pelvienne.

Résultats|

Soixante et une patientes (25 %) de cette série souhaitaient conserver leur fertilité. Un traitement médicochirurgical conservateur (TMC) a été proposé dans l’objectif d’améliorer la symptomatologie douloureuse de l’adénomyose tout en préservant l’utérus. Cinquante pour cent de ce groupe de patientes ayant bénéficié du protocole conservateur ont vu disparaître leur douleur pelvienne chronique à deux ans.

Abstract

Introduction|

Uterine adenomyosis is a very frequent factor for chronic pelvic pain. From 2001 to 2008, based on diagnostic criteria and score, chronic pelvic pain in 270 patients has been linked to uterine adenomyosis. The retrospective study of 246 medical records allowed us to validate these diagnostic criteria with 98% sensitivity and 90% specificity.

Discussion|

In this study, it was found that with hysterectomy, pelvic pain improved in 91% and disappeared in 81% of the cases. These results are much better than those obtained when hysterectomy is performed for pelvic pain in general. The 9% of failure could be related to visceral hypersensitivity.

Results|

Sixty-one patients (25%) of this study wanted to conserve their fertility. For these patients, a combined surgical and medical conservative treatment has been performed in order to treat the pelvic pain due to adenomyosis and preserve the uterus. Fifty percent of this group of patients were pain free for two years after the conservative treatment.

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Authors and Affiliations

  1. Unité de réhabilitation pelvi-périnéale, centre médical l’Avancée, 25, avenue Victor-Hugo, F-13100, Aix-en-Provence, France

    E. Bautrant, D. Thiers-Bautrant, J. Eggermont & R. Boyer

  2. Service de radiologie, centre hospitalier du pays d’Aix, avenue des Tamaris, F-13616, Aix-en-Provence, France

    M.A. Bryselbout & H. Cassin

  3. Unité de traitement de la douleur pelvienne, 8, calle professor Waksman, Madrid, Espagne

    F. Itza

Authors
  1. E. Bautrant
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  2. M.A. Bryselbout
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  3. D. Thiers-Bautrant
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  4. J. Eggermont
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  5. R. Boyer
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  6. H. Cassin
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  7. F. Itza
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Correspondence to E. Bautrant.

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Bautrant, E., Bryselbout, M., Thiers-Bautrant, D. et al. Syndrome douloureux pelvien chronique de l’adénomyose utérine: critères diagnostiques et traitement conservateur. Pelv Perineol 6, 42–45 (2011). https://doi.org/10.1007/s11608-010-0355-5

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  • DOI: https://doi.org/10.1007/s11608-010-0355-5

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