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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Objective: To assess the long-term genitourinary and gastrointestinal complaints following presacral neurectomy.Design: A prospective postoperative follow-up of patients who underwent laparoscopic presacral neurectomy and treatment of endometriosis.Materials and Methods: The mean follow-up of the 67 women (mean age 27.5 years, range 16-58 years) was an average of 36.8 months with a range of 6-69 years. Main outcome variables include diarrhea, constipation, bladder and urinary complaints, vaginal dryness, dyspareunia, and orgasm. The degree of pain and dysmenorrhea after surgery was also elevated.Results: Diarrhea was reported to have improved after surgery in 39.1% of the patients and none reported any worsening. Constipation improved in 28.6% and worsened in 12.5%. Only one patient suffered from debilitating constipation. Bladder and urinary problems were improved on 25.0% and worsened in 19.2%. A similar proportion of women (19.6%) reported improvement and worsening vaginal dryness. Pain during intercourse improved in 58.9% and worsened in 8.9%. The ability to achieve orgasm improved in 21.6% and worsened in 2.7%. Postoperatively, pain was improved by 80-100% in 46.6% of the women, by 50-80% in 36.5%, by less than 50% in 6.4%, and did not improve in 9.5%. Dysmenorrhea was improved by 80-100% in 35.2% of the women, by 50-80% in 38.8%, by less than 50% in 14.9%, and did not improve in 11.1%. Twelve of 16 patients trying to become pregnant were successful following surgery, two with the aid of in vitro fertilization.Conclusion: After laparoscopic presacral neurectomy, constipation and bladder and urinary problems were reported to have worsened in only a minority of patients. However, diarrhea and dyspareunia improved in a large proportion of patients. Since pelvic pain was relieved by more than 50% in 83.1%, the procedure seems to be associated with an acceptable rate of long-term side effects.
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PMID:Are the long-term adverse effects of laparoscopic presacral neurectomy for the management of central pain associated with endometriosis acceptable? 1083 74

Deep pelvic endometriosis is responsible of a painful syndrome dominated by deep dyspareunia and pelvic pain that recur according to the menstrual cycle. The semiology is directly correlated with the location of the lesions but is not specific. It is essential to investigate (clinically and with magnetic resonance imaging (MRI)) these deep endometriosis lesions and to draw up a precise map, which is the only way to be sure that surgical excisions will be complete. For the diagnosis of deep endometriosis, MRI is more sensitive and specific than endovaginal ultrasonography. Bowel and utero-sacral ligament lesions are often underestimated by clinical examination and ultrasonography. The MR diagnosis of these deep lesions is also difficult and require adapted sequences but may vary following experience of the radiologist. Preoperative endorectal ultrasonography or MRI are reliable techniques to visualize perirectal endometriomas and to assess rectal wall involvement. Surgical management can be based on preoperative imaging diagnosis, the Bladder and ureteral lesions are also underestimated. Renal ultrasonography must be performed in women affected by severe deeply infiltrating endometriosis. MRI does not improve sensitivity nor specificity of the radiologic diagnosis of ovarian endometriomas. Nevertheless, MRI is a reliable technique to visualize deeply infiltrating endometriosis lesions associated with ovarian endometriomas.
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PMID:[Imaging features of endometriosis]. 1496 60

Women seek gynecologic medical attention for 2 main reasons--abnormal bleeding and pelvic pain. Gynecologists are often more comfortable with the diagnosis and management of abnormal bleeding than with the diagnosis and management of pelvic pain. One reason is that chronic pelvic pain can result from a variety of abdominal and pelvic causes, including endometriosis, pelvic inflammatory disease, adhesions and urogenital causes, such as vulvodynia, and from bladder complaints, including overactive bladder, urinary tract infection and interstitial cystitis (IC). The symptoms of IC--chronic pelvic pain with urinary urgency, frequency and nocturia--are all too frequently attributed to these other causes of chronic pelvic pain, in large part because gynecologists rarely consider the bladder as a source of pelvic pain. In addition, IC can masquerade as, and coexist with, other causes of pelvic pain, particularly endometriosis. Early diagnosis and treatment of IC can reduce the occurrence of unnecessary procedures and treatments and can improve the patient's prognosis and quality of life. Bladder-origin pelvic pain should be considered in all women who present with these symptoms.
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PMID:Chronic pain syndromes of gynecologic origin. 1508 61

Bladder endometriosis is rare, although the bladder is the urinary tract structure most often affected by this condition. The common clinical manifestations of bladder endometriosis include menouria and urethral and pelvic pain syndrome occurring cyclically. Imaging methods are not conclusive for the definitive diagnosis. Cystoscopy is the most useful diagnostic test with confirmation by histologic study. Treatment must be individualized according to the patient's age, desire for future pregnancies, the severity of the symptoms, the site affected, and whether other organs are involved. Two types of treatment are currently used as follows: medical-hormonal and surgical.
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PMID:Update on the diagnosis and treatment of bladder endometriosis. 1736 25

In this article, we report a study that assessed the prevalence of interstitial cystitis (IC) in a primary care office using symptom-based and improved diagnosis-based assessment modalities. Over the course of 1 year, all patients > or = 18 years of age who presented for a primary care office visit were administered the Pelvic Pain and Urgency/Frequency (PUF) questionnaire. Patients with potential IC as indicated by PUF score were selected for further interview and, when appropriate, a Potassium Sensitivity Test (PST) or Anesthetic Bladder Challenge (ABC). Those given the PST were queried afterward regarding the tolerability of the test. Of 3883 patients initially surveyed, 13.1% (n +/- 509) reported PUF scores suggestive of probable IC, including 17.5% (357 of 2043) of women and 8.3% (152 of 1840) of men. Overall, 4.3% (168 of 3883) of patients in this primary care population was diagnosed with IC on the basis of history, PUF score, patient interview, and results of the PST or ABC. The PST was found to be comparable to, and in most cases less painful than, several standard office-based procedures. IC is a prevalent disease in the general primary care population. The PUF questionnaire represents an easy-to-use approach for IC symptom screening, and the PST and the ABC are useful and relatively noninvasive adjuncts in the diagnosis of IC.
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PMID:Prevalence of interstitial cystitis in a primary care setting. 1746 79

Interstitial cystitis (IC) is a chronic bladder inflammatory disease of unknown etiology that is often regarded as a neurogenic cystitis. IC is associated with urothelial lesions, voiding dysfunction, and pain in the pelvic/perineal area, and diet can exacerbate IC symptoms. In this study, we used a murine neurogenic cystitis model to investigate the development of pelvic pain behavior. Neurogenic cystitis was induced by the injection of Bartha's strain of pseudorabies virus (PRV) into the abductor caudalis dorsalis tail base muscle of female C57BL/6J mice. Infectious PRV virions were isolated only from the spinal cord, confirming the centrally mediated nature of this neurogenic cystitis model. Pelvic pain was assessed using von Frey filament stimulation to the pelvic region, and mice infected with PRV developed progressive pelvic pain. Pelvic pain was alleviated by 2% lidocaine instillation into either the bladder or the colon but not following lidocaine instillation into the uterus. The bladders of PRV-infected mice showed markers of inflammation and increased vascular permeability compared with controls. In contrast, colon histology was normal and vascular permeability was unchanged, suggesting that development of pelvic pain was due only to bladder inflammation. Bladder-induced pelvic pain was also exacerbated by colonic administration of a subthreshold dose of capsaicin. These data indicate organ cross talk in pelvic pain and modulation of pain responses by visceral inputs distinct from the inflamed site. Furthermore, these data suggest a mechanism by which dietary modification benefits pelvic pain symptoms.
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PMID:Organ cross talk modulates pelvic pain. 1762 30

Deep infiltrating endometriosis is a well-known female disease responsible for chronic pelvic pain, urinary dysfunction, infertility, and altered quality of life. Endometriosis and infertility are complex entities and the optimal choice of management of both of them remains obscure. Mechanism of development of the disease has to be understood to optimize patients care. The link between barrenness and endometriosis is well known, but there is no direct link between bladder lesion and infertility. Bladder endometriosis is a deeply infiltrating endometriosis lesion. Its management is first diagnostic and then remedial. In case of ineffectiveness of medical strategy, surgical treatment is indicated. However, for patient suffering from symptomatic isolated bladder endometriosis, surgical management can be offered in first intention. Isolated bladder injuries due to endometriosis are mostly treated by conservative laparoscopic surgery, after a complete evaluation of endometriosis disease and barrenness by clinical exam and imaging techniques.
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PMID:[Bladder endometriosis and barrenness: diagnostic and treatment strategy]. 1870 12

Despite the frequent association of urinary tract infection with vesicoureteral reflux and urinary calculi, since vesicouretal reflux is induced by bladder stones, the coexistence of vesicoureteral reflux and bladder stones is rare. Because of its occurrence in children belonging to poor socioeconomic groups, it is believed to be a deficiency disorder. Most cases of bladder stones occur between the ages of 2 and 5 years. Common clinical presentations of bladder stones include urinary dribbling and enuresis, frequency of micturition, pain during micturition, pelvic pain and hematuria. We report the occurrence of a large bladder stone in a boy, who experienced intermittent Lower abdominal pain and urinary incontinence, both during the day and at night. He had been diagnosed with enuresis and treated in pediatric clinics for 1 year. Delayed diagnosis resulted in bladder stone formation. The stone was larger than 2.5cm and open vesicolithotomy was therefore selected as the best and safest treatment choice. His symptoms disappeared after surgery. Thorough metabolic and environmental evaluations of such cases are required on an individual basis. Bladder stones should be considered as a possible diagnosis in children presenting with urinary incontinence.
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PMID:A boy with a large bladder stone. 1905 22

Bladder leiomyomas account for less than 0.43% of all bladder tumors, and these comprise about 35% of mesenchymal tumors [1,2]. About 250 cases of bladder leiomyoma have been reported in the English literature to date [3]. A patient may or may not have symptoms, according to the location and size of the leiomyoma. Initial symptoms include urinary frequency, urgency, hematuria, and pelvic pain [4]. Treatment for bladder leiomyoma includes abdominal, vaginal, laparoscopic, or transurethral resection. Herein, we present the first case, to our knowledge, of bladder leiomyoma that was laparoscopically enucleated without cystotomy.
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PMID:Laparoscopic enucleation of a bladder leiomyoma. 1989 8

There is a clear relationship between the pelvic floor muscles and urinary systems, which relates to urgency, frequency, incontinence, pelvic pain, and bowel complaints. The specific mechanisms which relate these two systems are not clear. Improved understanding of the relation between the pelvic floor muscles and bladder function is clinically relevant in establishing effective treatments to such problems as incontinence, secondary to birth. The following tissues were collected from normal adult female rabbits: pubococcygeus (Pc) and ischiocavernosus/bulbospongiosus (Ic/Bs) pelvic floor muscles. Bladder body muscle and mucosa, bladder base muscle and mucosa, and leg skeletal muscle were also collected. The following enzymatic assays were performed on each tissue: citrate synthase (CS), sarcoplasmic-endoplasmic reticular ATPase (SERCA), and choline acetyltransferase (ChAT). CS and SERCA activities were significantly higher in the Pc compared with the Ic/Bs pelvic floor muscles, whereas the ChAT activity of the Ic/Bs was higher than that of the Pc muscle. Based on our results, the Pc muscle is expected to have a significantly greater capacity to contract and a higher metabolic activity than those of the Ic/Bs muscles. We believe that an understanding of the biochemical activities of these three biomarker enzymes in normal pelvic floor muscles is essential in evaluating the effects of specific experimental dysfunctions created in pelvic floor muscle activity.
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PMID:Citrate synthase, sarcoplasmic reticular calcium ATPase, and choline acetyltransferase activities of specific pelvic floor muscles of the rabbit. 2291 11


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