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

The purpose of this study was to determine the efficacy of laparoscopic-assisted vaginal hysterectomy utilising the contact-tip Nd:YAG (Neodymium: Yttrium-Aluminum-Garnet) laser (Surgical Laser Technologies, Oaks, PA). Postoperative activity levels, operative times, blood loss, pain medication use, length of hospital stay, and complications of laparoscopic-assisted vaginal hysterectomy were determined. Sixty-seven women with extensive disease including endometriosis, adenomyosis, adhesions, and multiple fibroids underwent laparoscopic-assisted vaginal hysterectomy (LAVH). The procedures were performed utilising the contact-tip Nd:YAG laser and a laparoscopic linear stapling device. All patients were operated on for a primary diagnosis of pelvic pain and would have required an abdominal approach for surgery due to extensive adhesions, fibroids, or endometriosis. Sixty-eight cases of laparoscopic-assisted vaginal hysterectomy were attempted. In 67 of these cases, the procedure was completed as planned. One case required conversion to abdominal hysterectomy due to extensive adhesions. Average hospital stay after surgery was 2.7 days with a minimum stay of less than one day. The average operating time for the LAVH was 149 minutes with an estimated blood loss of 220 mL and a haemoglobin drop from surgery to day 1 after surgery of 1.9 g. The complication rate was 11.9% with all of the complications occurring in the first 46 cases. By day 14 after surgery, patients reported their activity level at 8.8 on a scale of 1 to 10 with 10 being unlimited activities. By day 21, they reported their activity level at 9.5. The majority of the patients were able to return to work within two weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Laparoscopic-assisted vaginal hysterectomy utilising the contact-tip Nd: YAG laser: a review of 67 cases. 818 62

Physicians are beginning more and more to understand pelvic pain syndrome (PPS). Transuterine pelvic venography shows that some women who suffer from chronic pelvic pain have moderate or severe congestion. On the other hand, laparoscopy indicates that some cases have no physical abnormalities. A psychological component is frequently involved, but automatically referring a woman with PPS to a psychiatrist is unproductive. Instead, physicians should involve a psychologist based at a gynecologic clinic, especially in the case of women with a history of sex abuse with a high somatization score. In the case of women who suffer from PPS but clearly show no apparent physical causes, physicians should not investigate any further, but instead reassure them. Reassurance usually results in alleviation of pain within 6 months. PPS only strikes premenopausal women, suggesting that ovarian activity may also be involved. Thus, treating women with hormones to suppress ovulation benefits some women. The medical community still does not know whether longterm treatment with gonadotropin-releasing hormone analogues and hormone replacement effectively eliminates pelvic pain. If the above treatments do not successfully treat PPS, physicians can perform a hysterectomy and bilateral oophorectomy and prescribe sufficient hormone replacement therapy to remove heretofore undetected disease (e.g., ovarian cysts, adenomyosis, and fibroids) in 33% of cases of idiopathic PPS and alleviate pelvic pain in 66% of such cases.
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PMID:The pelvic pain syndrome. 833 82

Leuprolide acetate was used to produce a constant hypoestrogenic environment in a young patient with histologically confirmed adenomyosis. Conservative medical therapy was initiated because of the patient's complaint of severe dysmenorrhea coupled with her strong desire for uterine conservation. The initial daily subcutaneous dose was eventually converted to monthly intramuscular depot formulation for patient convenience. A dramatic therapeutic response was observed with each course of therapy. This included a marked reduction in uterine size, amenorrhea, and complete resolution of pelvic pain. Cyclic use of an OC agent following LA was associated with a return of symptoms and uterine growth. The patient did, in fact, conceive immediately on cessation of analogue therapy.
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PMID:Long-term management of adenomyosis with a gonadotropin-releasing hormone agonist: a case report. 842 43

Adenomyosis is an underestimated pathology frequently responsible of unknown origin pelvic pain and uterine enlargement. It is hyperestrinic condition with poor specific symptomatology and preoperative diagnostic tools are very few. The most important of them, ultrasound, has improved its diagnostic capacity with the introduction of transvaginal way of examination. However, for the ultrasound resemblance, the common etiopathogenetic origin and the symptomatologic likeness between adenomyosis and uterine leiomyomatosis, a problem still open is the differential diagnosis between these two pathologies especially when both are present in the same subject. In our study where the preoperative ultrasound was followed by surgical finding, we try to give some ultrasonographical guidelines to discern among these two pathologic conditions.
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PMID:Transvaginal ultrasonographic diagnosis of adenomyosis in female patients suffering from uterine fibromatosis. 900 78

Hysterectomy, the most common major nonobstetric operation, is performed in more than 570,000 women in the United States each year. Although the number of hysterectomies has decreased in recent years, many authorities believe that hysterectomy is often unnecessary and unjustified. There is no universally accepted set of criteria regarding the appropriate indications for hysterectomy. The main indications for hysterectomy include the following conditions: uterine leiomyomas, dysfunctional uterine bleeding, endometriosis/adenomyosis, chronic pelvic pain and genital prolapse. Current literature, however, routinely recommends conservative management of most nonmalignant gynecologic conditions, with hysterectomy reserved for refractory cases. Several nonmedical factors, such as patient race, age, geographic location, medical history and background, as well as health care provider characteristics, such as time since completion of training, gender, and affiliation with teaching hospitals, are also associated with hysterectomy rates.
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PMID:Hysterectomy: indications, alternatives and predictors. 933 35

Ninety-three women in whom conservative surgical therapy for chronic pelvic pain failed required hysterectomy for control of their disabling condition. In 22 of these 93 patients (24%), adenomyosis was the major pathologic finding. In 10 of the 22 (45%) women who had adenomyosis and required hysterectomy for control of their pain, tubal ligation had been previously performed. Only 15% (11/71) of patients without adenomyosis had had a tubal ligation. Over 23% of patients requiring hysterectomy for control of chronic severe pelvic pain had adenomyosis, and almost half of these women had had a tubal ligation performed. The possible relationship of adenomyosis to a previous tubal ligation has been explored.
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PMID:Adenomyosis as a Major Cause for Laparoscopic-Assisted Vaginal Hysterectomy for Chronic Pelvic Pain 907 63

One hundred patients were treated with laparoscopic techniques for chronic pelvic pain. These procedures included uterosacral nerve vaporization, resection and vaporization of endometriosis, hernia repair, appendectomy, presacral neurectomy, and ovarian surgery. Follow-up over a 3 year period revealed the following results. Women with significant endometriosis had a 75% cure rate with a change in quality of life index from a preoperative level of pain of 8 to a postoperative level of pain of 2. A Score of 1 is no pain and 10 is maximum pain. Patients who did not have endometriosis had an 80% cure rate with a reduction in pain level to an average of 2 from preoperative levels averaging 9. The results and trends from these procedures indicate that approximately 75% of all patients with chronic pelvic pain can be successfully treated by conservative laparoscopic techniques. Adenomyosis has been demonstrated to be the condition resulting in the most failures of treatment.
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PMID:Laparoscopic Treatment for Chronic Pelvic Pain: Results from Three-Year Follow-up 907 64

Nine cases of adenomyosis after endometrial resection are examined. Patients' symptoms were menorrhagia prior to initial resection, and patients had normal ultrasounds prior to their first procedure. All of the patients underwent resection without hormonal preparation. None had adenomyosis on resection specimens. After resection, five complained of cyclic pelvic pain, and four had dysmenorrhea. The onset of symptoms varied from 7 to 60 months. Ultrasound findings consistent with adenomyosis were reported in seven patients. Five patients had repeat resection procedures; specimens all showed adenomyosis on tissue report. Two patients are asymptomatic after the repeat resection. One patient continues on suppressive therapy with partial relief of symptoms. Two required hysterectomy for continued pain. In total, six patients required hysterectomy for continued dysmenorrhea or pelvic pain; at surgery the diagnosis of adenomyosis was confirmed.
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PMID:Does Endometrial Resection Cause Adenomyosis? 907 15

Hysterectomy is the commonest major operation performed by gynaecologists and is the definitive cure for many of it's indications which include dysfunctional uterine bleeding, fibroids, utero-vaginal prolapse, endometriosis and adenomyosis, pelvic inflammatory disease, pelvic pain, gynaecological cancers and obstetric complications. It is a successful operation in terms of relieving women of their presenting symptoms and high levels of satisfaction are reported by patients. However, it has a high risk of complications, involves a prolonged convalescence, is expensive and to some women represents a loss of femininity. It should only be employed after trying conservative treatments first if appropriate. If this fails, currently only endometrial ablation and myomectomy are valid alternatives to hysterectomy. If ultimately hysterectomy is required, there is considerable evidence that patient care can be improved by increasing the proportion of operations that are done vaginally and laparoscopically and decreasing the number of laparotomies.
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PMID:Indications and alternatives to hysterectomy. 915 36

The outcome of abdominal hysterectomy for pelvic pain in premenopausal women was studied retrospectively in 228 women. In 17 women, pelvic pain was the sole indication while in the others, pelvic pain was one of the contributory indications for hysterectomy. The most common surgical histopathological diagnoses were uterine leiomyoma (73.9%), uterine adenomyosis (40.4%), benign ovarian cyst (19.3%) and endometriosis (7.9%); 118 (51.8%) patients had single pathology and 48.2% had multiple pathologies. The agreement between operative clinical diagnosis and histopathological diagnosis was 66.1% for leiomyoma, 57.1% for uterine adenomyosis and 30% for endometriosis. The incidence of early postoperative complication was 20.6%, mainly minor morbidities including urinary tract infection (3.9%), wound infection (3.1%) and unexplained fever (6.0%). These complications significantly prolonged the duration of hospital stay from an average of 7 days to 9-17 days. Of 98 patients with pain as the sole or the most predominant indication for hysterectomy, 72% responded to an outcome survey 12 or more months after hysterectomy. Of these, 62 (87%) were satisfied with the operation, 8 were unsure and 1 was dissatisfied; 68 (95.8%) patients reported relief of their symptoms. Relief of symptoms did not correlate with the patient's report of her satisfaction with hysterectomy. Pain in the abdominal wound a year or more after surgery was one of the commonest reasons cited for dissatisfaction with hysterectomy. We conclude that in well-selected cases, hysterectomy is an appropriate and satisfactory treatment for premenopausal women with pelvic pain irrespective of clinical evidence of associated pathology. Effective measures to reduce postoperative complications and wound pain are needed to further improve the outcome of abdominal hysterectomy.
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PMID:Outcome of hysterectomy for pelvic pain in premenopausal women. 952 96


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