Endometriosis in the presacral nerve (original) (raw)
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Fertility and Sterility, 2009
Objective: To investigate the clinical relevance of endometriosis-associated nerve fibers in the development of endometriosis-associated symptoms. Design: Prospective nonrandomized study. Setting: University hospital endometriosis center. Patient(s): Fifty-one premenopausal patients underwent surgical laparoscopy because of chronic pelvic pain, dysmenorrhea, or for ovarian cysts. Endometriosis was diagnosed in 44 patients. Intervention(s): The preoperative and postoperative pain scores were determined using a standardized questionnaire with a visual analogue scale from 1-10. Patients with peritoneal endometriosis were divided into two groups depending on their preoperative pain score: group A with a pain score of at least 3 or more and group B with a pain score of 2 or less. Patients without peritoneal endometriosis were classified as group C and patients without endometriosis were classified as group D. Immunohistochemical analysis of neurofilament and protein gene product 9.5 were used for nerve fiber detection. Occurrence of endometriosis-associated nerve fibers was correlated with the severity of pelvic pain and/or dysmenorrhea. Result(s): Peritoneal endometriosis-associated nerve fibers were found significantly more frequently in group A than in group B (82.6% vs. 33.3%). Conclusion(s): The present study suggests that the presence of endometriosis-associated nerve fibers in the peritoneum is important for the development of endometriosis-associated pelvic pain and dysmenorrhea.
Nerve Fibers and Histopathology of Endometriosis-Harboring Peritoneum
The Journal of the American Association of Gynecologic Laparoscopists, 2001
The association between endometriosis and pelvic pain is unclear. Endometriosis is often associated with pain, but it is also present in up to 15% of asymptomatic women. 1 In those with pelvic pain, it is thought that the disease can stimulate nerve endings, resulting in tender lesions on pelvic examination or on probing during laparoscopy under conscious sedation. 2,3 To identify nerve fibers, we reported immunocytochemistry staining with a monoclonal antibody to neurofilament. We found no difference in the proportion and mean nerve score in adhesions due to previous intraabdominal infection, endometriosis, and previous intraabdominal surgery. In the present study we evaluated the histopathology and presence of nerve fibers in peritoneum of women with and without endometriosis.
Diagnosis of endometrial nerve fibers in women with endometriosis
Archives of Gynecology and Obstetrics, 2011
Purpose Recent studies indicated that there is a high density of small nerve Wbers in the functional layer of the endometrium in women with endometriosis and that it can be used as a marker to detect endometriosis. In this study, the eYcacy assessment of small nerve Wbers' density as a diagnostic marker was compared in patients with and without endometriosis. Methods In this study, women with history of pelvic pain and/or infertility who were candidates for laparoscopy or laparotomy in Rassoul hospital (2007-2009) were enrolled. Histological sections of endometrial tissue were prepared from endometrial biopsy from women with endometriosis (n = 12) (1) and without endometriosis (n = 15) (2). Protein gene product 9.5 and neuroWlament were evaluated as marker from endometrial biopsies by immunohistochemical methods. Results There was no statistically signiWcant diVerence between two groups according to age, body mass index. Nerve Wbers were detected in all endometrial biopsies from all women with endometriosis but detected only in three women without endometriosis. The mean density of nerve Wbers was 2.2 § 4.7 mm ¡2 in group without endometriosis and) 13.1 § 3.3 (in group with endometriosis (p < 0.001). Women with endometriosis had signiWcantly higher nerve Wber density in comparison with women without endometriosis. Conclusions Our Wndings indicated that endometrial biopsy for detecting density of nerve Wbers by usage of protein gene product 9.5, provided a reliable marker for diagnosis of endometriosis.
Journal of Minimally Invasive Gynecology, 2006
Pelvic pain associated with endometriosis is a common clinical problem. In approximately 20% of cases endometriosis-related pelvic pain is either minimally or not responsive to medical treatment; thus surgical treatment seems to be a valid option. The aim of this review is to describe presacral neurectomy surgical techniques, data regarding safety and efficacy of this procedure, its indications, and future research on its applications in clinical practice.
Human Reproduction, 2009
background: Diagnosis of endometriosis currently requires a laparoscopy and this need probably contributes to the considerable average delay in diagnosis. We have reported the presence of nerve fibres in the functional layer of endometrium in women with endometriosis, which could be used as a diagnostic test. Our aim was to assess efficacy of nerve fibre detection in endometrial biopsy for making a diagnosis of endometriosis in a double-blind comparison with expert diagnostic laparoscopy. methods: Endometrial biopsies, with immunohistochemical nerve fibre detection using protein gene product 9.5 as marker, taken from 99 consecutive women presenting with pelvic pain and/or infertility undergoing diagnostic laparoscopy by experienced gynaecologic laparoscopists, were compared with surgical diagnosis.
Fertility and Sterility, 2007
Objective: To investigate types of nerve fibers in endometrium and myometrium in women with endometriosis. Design: Laboratory study using human tissue. Setting: University-based laboratory. Patient(s): Women with and without endometriosis undergoing hysterectomy. Intervention(s): Histologic sections of contiguous endometrial and myometrial tissues were prepared from hysterectomies performed on women with and without endometriosis. Main Outcome Measure(s): Types and density of nerve fibers in endometrium and myometrium in women with and without endometriosis were determined using a series of specific markers for neuronal structure and function: PGP9.5, NF, SP, CGRP, TH, VAChT, VIP, and NPY. Result(s): Nerve fibers stained with PGP9.5 and NF in endometrium and myometrium were significantly increased in women with endometriosis compared with women without endometriosis. Nerve fibers in the functional layer of endometrium in women with endometriosis were likely to be sensory C, a mixture of sensory Ad, sensory C, and adrenergic fibers in the basal layer of the endometrium, a mixture of sensory Ad, sensory C, adrenergic and cholinergic fibers in the myometrium. Conclusion(s): Increased nerve fiber density in endometrium and myometrium, and sensory C fibers and adrenergic nerve fibers in the endometrium in women with endometriosis may play an important role in the mechanisms of pain generation in this condition. (Fertil Steril Ò 2007;88:795-803.
Obstetrics & Gynecology Science, 2021
Objective The primary objective of this study was to establish the presence of nerve fibers in the eutopic endometrium of women with endometriosis and to determine whether these nerve fibers are exclusive to endometriosis or are also found in other pelvic pathologies associated with dysmenorrhea.Methods Endometrial tissue was obtained by aspiration (Pipelle), endometrial curettage, or following hysterectomy in women with endometriosis confirmed through histopathological examination, leiomyomas, and adenomyosis. The eutopic endometrium was subjected to immunohistochemical staining to detect PGP 9.5, which is a highly specific pan-neuronal marker. The nerve fiber density was correlated with the patient’s pain score, as indicated by the Visual Analog Scale. A control group was formed by staining the endometrium of women presenting with dysmenorrhea but without the above-mentioned disorders.Results Nerve fibers were observed in sections of the endo-myometrium (in the deep endometrium) i...
Effects of presacral neurectomy on pelvic pain in women with and without endometriosis
Ginekologia polska, 2009
Presacral neurectomy (PSN) is used in treatment of central chronic pelvic pain (CPP); however, the confounding effect of concomitant resection of endometriosis remains uncertain. This study was undertaken to evaluate and compare the effectiveness of presacral neurectomy (PSN) in the presence and absence of endometriosis. Twenty-three women with midline CPP (age 30.3 +/- 7.9, range 21-46) unresponsive to medical therapy were recruited to the study. Endometriosis was absent in seven and present in sixteen subjects. Laparoscopic PSN using a harmonic scalpel was performed in all subjects; simultaneous excision of endometriotic lesions was also carried out in subjects with endometriosis. Intensity of dysmenorrhoea and pelvic pain was measured by visual analogue pain scale (VAPS) at 3 and 12 months postoperatively. Dysmenorrhoea decreased at 3 months by 75% (P = 0.018) in those without endometriosis and by 78% (P = 0.001) in those with endometriosis. At 12-months, dysmenorrhea increased i...
Nerve fibres in peritoneal endometriosis
Human Reproduction, 2006
BACKGROUND: Endometriosis is a gynaecological disease that can be associated with severe pelvic pain; however, the mechanisms by which pain is generated remain unknown. METHODS: Peritoneal endometriotic lesions and normal peritoneum were prepared from women with and without endometriosis (n = 40 and 36, respectively). Specimens were also prepared from endosalpingiosis lesions (n = 9). These sections were stained immunohistochemically with antibodies against protein gene product 9.5, neurofilament (NF), nerve growth factor (NGF), NGF receptor p75 (NGFRp75), substance P (SP), calcitonin gene-related peptide (CGRP), acetylcholine (ACh) and tyrosine hydroxylase (TH) to demonstrate myelinated, unmyelinated, sensory, cholinergic and adrenergic nerve fibres. RESULTS: There were significantly more nerve fibres identified in peritoneal endometriotic lesions than in normal peritoneum (P < 0.001) or endosalpingiosis lesions (P < 0.001). These nerve fibres were SP, CGRP, ACh or TH immunoreactive. Many of these markers were co-localized. There was an intense NGF immunoreactivity near endometriotic glands, and NGFRp75 immunoreactive nerve fibres were present near endometriotic glands and blood vessels in the peritoneal endometriotic lesions. CONCLUSIONS: Peritoneal endometriotic lesions were innervated by sensory Ad, sensory C, cholinergic and adrenergic nerve fibres. These nerve fibres may play an important role in the mechanisms of pain generation in this condition.