Chronic pelvic pain in women: comparative study between ultrasonography and laparoscopy as diagnostic tool (original) (raw)
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Role of diagnostic laparoscopy in women with chronic pelvic pain
International journal of health sciences
Background and Aim: Chronic pelvic pain can be diagnosed and treated with laparoscopy, which can reveal findings that cannot be detected clinically. There are many health related issues associated with chronic pelvic pain, and it negatively impacts overall health and ability to work. An assessment of diagnostic laparoscopy's role in chronic pelvic pain women was the purpose of the present study. Patients and Methods: This cross-sectional study was carried out on 98 women (16-45 years) present with chronic pelvic pain attended the Gynecology and Obstetrics Department of Khyber Teaching Hospital, Peshawar from June 2020 to June 2021. Study protocol was approved by institute research and ethical committee. Women with chronic pelvic pain (>6 months) without obvious pathological findings based on ultrasound and clinical examination were enrolled. Clinical findings, laparoscopic data, and ultrasound examination of each individual was recorded. SPSS version 28 was used for data anal...
2017
Annals of PIMS ISSN:1815-2287 Ann. Pak. Inst. Med. Sci. 2016 196 Introduction Chronic pelvic pain is described as non-cyclical, constant or intermittent , pain in the lower abdomen lasting for at least six months duration which is severe enough to cause functional disability and is not completely relieved by medical treatment. It may or may not be associated with menstrual cycle or intercourse It is a common debilitating condition affecting women presenting in gynaecological outpatient clinics. It accounts for substantial personal suffering and health care expenditure for diagnosis and treatment. The source of chronic pelvic pain may be either gynaecological or non gynaecological. The usual gynaecological causes of chronic pelvic pain are, endometriosis, pelvic adhesions due to inflammation or previous surgery, uterine fibroids, pelvic congestion syndrome, adenomyosis , ovarian cyst and residual ovary syndrome. The non gynaecological causes of chronic pelvic pain may be, gastrointes...
Introduction: Chronic pelvic pain (CPP) is intermittent or constant pain in the lower abdomen or pelvis for at least six months duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy. This chronic pelvic pain (CPP) is poorly understood, and may have significant impact on a woman’s health. Transvaginal sonography (TVS) and laparoscopy are useful in the evaluation of women with CPP. This research was designed to study role of TVS and diagnostic laparoscopy in chronic pelvic pain. Materials and Methods: This prospective study was done at Lalla Ded Hospital from August 2011 to July 2014. All female patients who had clinical diagnosis of CPP were evaluated with the TVS and laparoscopy and findings were recorded. Results: Total of 80 women had CPP. Normal TVS was present in 41 cases (51.25%). The remaining 39 (48.75%) had an abnormal scan. Laparoscopic confirmation of pelvic pathology was reported in 40 cases with abnormal scan but normal scan was confirmed only in 10 (12.50%) cases. Conclusion: In spite of similar specificity and positive predictive value, laparoscopy although being an invasive procedure still has got distinct advantages over TVS in terms of sensitivity and negative predictive value indicating its superiority in management.
Objective: Laparoscopic evaluation in the chronic pelvic pain causes were the objective of our research, so to offer an appropriate treatment to the affected patients and reduce unnecessary hospital follow-up visits including reduced antibiotics use was the aim of this research. Material and Methods: The design of this study was a descriptive study. This study was carried out at Benazir Bhutto Hospital Rawalpindi and the duration of this study was from January 2020 to June 2020. Sample population of 4301 patients who visited the OPD. The research sample included OPD cases as 271 having an incidence of chronic pelvic pain. Interview was taken and investigation was made in those patients. Patients who failed to answer were treated with laparoscopy. After consent 33 cases were selected for the laparoscopy. Necessary information and investigation were carried out in the patients. Serious cases of lung and heart, peritonitis, abdominal operations, intestinal obstruction and malignancy were not made a part of the research study. We also carried out diagnostic laparoscopy in the supervision of general anesthesia and operative outcomes were also observed in the prescribed form. SPSS-11 was used for data entry and analysis. Results: In the thirty-three cases, maximum were in the age group of 31 -41 years as 17 cases (51.52%) the ratio of multi-parous was (57.58%). Deep and dull pelvic pain was observed in 17 cases (51.52%) including sharp occasional episodes. Hospitalization in the case of acute pain cases was required in 03 patients (9.1%). Sub-fertility was complained by 11 patients (33.33%), 7 cases were of dysmenorrhea (21.21%); whereas dysfunctional bleeding was observed in 05 patients (15.15%). Only 04 patients (12.12%) registered low back ache complain in the region of lumbosacral. No complain was observed in 7 patients (21.21%). Bulky uterus was observed in 11 patients (33.33%). We left the adnexal masses in 06 patients (18.18%); whereas, 05 cases (15.15%) were having nodularity in Douglas pouch. In terms of laparoscopic outcomes 11 patients (33.33%) were observed with chronic inflammatory pelvic disease. Different endometriosis degrees were also observed in 09 patients (27.27%). No abnormality was noticed in 04 patients (12.12%). Conclusion: Our research puts force on the laparoscopy importance for the evaluation of chronic pelvic cause in the patients. This technique requires due consideration as it is very essential managerial investigation in the cases having unnecessary and repeated antibiotic use with associated avoidable drugs.
Australian and New Zealand Journal of Obstetrics and Gynaecology
Background: Clinician and patient factors impact on the management of chronic pelvic pain (CPP) with medical, surgical or combined approaches possible, although none have proven superior. Aims: To understand the characteristics of women offered laparoscopic pelvic surgery for CPP. Materials and methods: We performed an observational study of women referred with CPP. They were asked to complete a study questionnaire regarding their symptoms, medical history, quality of life and pain catastrophisation. Examination and ultrasound findings were collected from patient records. Gynaecologists who recommended a laparoscopy completed a survey detailing their reasoning at the time of booking. The outcomes were investigated using a Cox proportional hazards ratio (HR) model. Results: Of 211 participants, 59 (28%) were booked for laparoscopic surgery during the study timeframe. Factors increasing the rate of laparoscopy included severe dysmenorrhoea (Cox HR = 1.94; P = 0.017), unsuccessful trial of hormonal therapy (Cox HR = 1.81; P = 0.044), prior abdominal surgery (Cox HR = 1.79; P = 0.030), prior pelvic laparoscopy (Cox HR = 2.00; P = 0.007) and past diagnosis of endometriosis (Cox HR = 5.44; P = 0.010). Abnormal vaginal examination (Cox HR = 2.86; P = 0.019) and ultrasound probe tenderness (Cox HR = 2.52; P < 0.001) also increased the likelihood of surgery. Surgical and non-surgical patients did not differ in family history, quality of life or pain catastrophisation. Of gynaecologists' questionnaires, 75% were returned. Results indicated they were most influenced by the severity or duration of pain and least by examination or ultrasound findings. Conclusions: The characteristics of women booked for surgery were in keeping with the features evidence suggests increases the risk of pathology. There were some discrepancies between patient characteristics elicited in the questionnaires and those indicated by gynaecologists to influence their decision.
Role of laparoscopy in evaluation of chronic pelvic pain
Journal of Minimal Access Surgery, 2005
Introduction: Chronic pelvic pain (CPP) is a common medical problem affecting women. Too often the physical signs are not specific. This study aims at determining the accuracy of diagnostic laparoscopy over clinical pelvic examination. Settings and Design: A retrospective study of patients who underwent diagnostic laparoscopy for CPP. Materials and Methods: The medical records of 86 women who underwent laparoscopic evaluation for CPP of at least 6-month duration were reviewed for presentation of symptoms, pelvic examination findings at the admission, operative findings and follow up when available. Statistical analysis used: McNemar Chi-square test for frequencies in a 2 x 2 table. Results: The most common presentation was acyclic lower abdominal pain (79.1%), followed by congestive dysmenorrhoea (26.7%). 61.6% of women did not reveal any significant signs on pelvic examination. Pelvic tenderness was elicited in 27.9%. Diagnostic laparoscopy revealed significant pelvic pathology in 58% of those who essentially had normal pervaginal findings. The most common pelvic pathology by laparoscopy was pelvic adhesions (20.9%), followed by pelvic congestion (18.6%). Laparoscopic adhesiolyis achieved pain relief only in one-third of the women. Conclusion: The study revealed very low incidence of endometriosis (4.7%). Overall clinical examination could detect abnormality in only 38% of women, where as laparoscopy could detect significant pathology in 66% of women with CPP. This shows superiority of diagnostic laparoscopy over clinical examination in detection of aetiology in women with CPP (P < 0.001). Adhesiolysis helps only small proportion of women in achieving pain control.
evaluated the laparoscopic surgery results for CPP, the anathomo-pathological exams and the CPP protocol filled up during appointments before laparoscopy. Results: Thirty-six patients were submitted to laparoscopy. Fifty percent of the patients reported cyclical pain and ninety five percent of the patients had dysmenorrheal and dyspareunia complaint. History of Sexually Transmitted Disease (STD) or PID was present in 43% and 48% of the cases, respectively. The most common contraceptive method used was oral contraceptive by 55,6% of the patients, followed by tubal ligation and condoms , both with 11% rate. Anamnesis revealed 8,3% of obesity, 22% of tobacco users and 6% suffer from depression. Almost half of the patients revealed familial history of endometriosis (47%), wherein 37% of patients with endometriosis diagnosis from laparoscopy had a positive familial history of the disease. Physical examination revealed abdominal scar in 53% of the patients, pain during palpation in 67%, and pain at uterine cervix mobilization in 80%. At laparoscopy we observed high prevalence of endometriosis as a cause of Chronic Pelvic Pain (58,3%). From all patients with endometriosis diagnosis, 50% were classified as stage I, and 50% as stage IV. Discussion: More than a half of the patients with CPP presented endometriosis diagnosis. We observed an expressive percentage of patients with mild endometriosis. In these cases pain could be justified by the production of local inflammatory factors in atypical lesions that are active biologically. In accordance with the literature there is no correlation between pain due to endometriosis and the stage of the disease.
International Journal of Environmental Research and Public Health
Background: Chronic pelvic pain affects approximately 15% of reproductive age women. It is mainly caused by adhesions (20–40%). Despite CPP being the main symptom of endometriosis, the disease is confirmed by laparoscopy only in 12–18% of cases. The aim of this study was to evaluate the results of laparoscopy in women with CCP and to assess the sensitivity and specificity of elements of an interview and clinical examination. Materials and methods: The study included 148 women with CPP. Each patient underwent laparoscopy. In laparoscopy, the presence of endometriosis and/or peritoneal adhesions was confirmed. Then, the sensitivity and specificity and the positive and negative predictive value of endometriosis symptoms or abnormalities in the gynecological examination were statistically calculated. Results: After previous surgery, adhesions were found in almost half (47%) of patients. In patients without a history of surgery, adhesions were diagnosed in 6.34% of patients. Endometriosi...
Chronic female pelvic pain--part 1: clinical pathoanatomy and examination of the pelvic region
Pain practice : the official journal of World Institute of Pain, 2012
Chronic pelvic pain is defined as the presence of pain in the pelvic girdle region for over a 6-month period and can arise from the gynecologic, urologic, gastrointestinal, and musculoskeletal systems. As 15% of women experience pelvic pain at some time in their lives with yearly direct medical costs estimated at $2.8 billion, effective evaluation and management strategies of this condition are necessary. This merits a thorough discussion of a systematic approach to the evaluation of chronic pelvic pain conditions, including a careful history-taking and clinical examination. The challenge of accurately diagnosing chronic pelvic pain resides in the degree of peripheral and central sensitization of the nervous system associated with the chronicity of the symptoms, as well as the potential influence of the affective and biopsychosocial factors on symptom development as persistence. Once the musculoskeletal origin of the symptoms is identified, a clinical examination schema that is base...
An odyssey through chronic pelvic pain in women
Frontiers in Women’s Health
The five common conditions encountered in patients with chronic pelvic pain (CPP) consist of endometriosis, interstitial cystitis, pelvic floor dysfunction, irritable bowel syndrome and pudendal nerve entrapment. The most unrecognised cause of CPP is the latter which affects only 4% of patients. A thorough work up of patient's pain is necessary prior to subjecting patients to any intervention including surgery as over 40% of gynaecological laparoscopies are performed for long standing pelvic pain. CPP is of multi-source origin which makes it difficult in formulating a plan of care for patients with this condition. If one source of the pain is detected, it is important to rule out other conditions that may also be contributing. All practitioners treating patients with CPP have to be knowledgeable about all of the potential causes of pelvic pain and addressing only the commonest cause like endometriosis is not adequate.