Risks, symptoms, and management of pelvic nerve damage secondary to surgery for pelvic organ prolapse: a report of 95 cases.
Summary of "Risks, symptoms, and management of pelvic nerve damage secondary to surgery for pelvic organ prolapse: a report of 95 cases."
INTRODUCTION AND
HYPOTHESIS:
This study aims to report pelvic nerve damage secondary to surgical treatment of pelvic organ prolapse and the role of laparoscopy in the diagnosis and treatment of such nerve damage.
METHODS:
Ninety-five consecutive patients complaining of pain and/or bladder or bowel dysfunction following surgery for pelvic prolapse underwent laparoscopic exploration for pelvic neuropathy.
RESULTS:
A mean reduction in visual analog score (VAS) from 8.9 (±0.96; 6-10) preoperatively to 2.9 (±2.77; 0-6) at 1-year follow-up was obtained in patients after laparoscopic nerve decompression (n = 90; p < 0.001). Success, defined as a reduction in VAS score of greater than 50%, was obtained in 84% of patients. Sixty-five patients (68%) discontinued the regular use of analgesics.
CONCLUSIONS:
Because secondary nerve damage can appear months or years after the primary procedure, long-term follow-up is mandatory and should focus on nerve damage as well as anatomical and functional outcomes. Laparoscopy is a unique method for etiologic diagnosis and neurosurgical treatment of such nerve lesions through decompression or implantation of an electrode for neuromodulation.
Affiliation
Department of Surgical Gynecology & Neuropelveology, Hirslanden Clinic, Witellikerstrasse 40, 8032, Zürich, Switzerland, marc.possover@hirslanden.ch.
Journal Details
This article was published in the following journal.
Name: International urogynecology journal
ISSN: 1433-3023
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21979388
- DOI: http://dx.doi.org/10.1007/s00192-011-1539-4
Medical and Biotech [MESH] Definitions
Hypogastric Plexus
A complex network of nerve fibers in the pelvic region. The hypogastric plexus distributes sympathetic fibers from the lumbar paravertebral ganglia and the aortic plexus, parasympathetic fibers from the pelvic nerve, and visceral afferents. The bilateral pelvic plexus is in its lateral extent.
Culdoscopy
Endoscopic examination, therapy or surgery of the female pelvic viscera by means of an endoscope introduced into the pelvic cavity through the posterior vaginal fornix.
Hyperalgesia
An increased sensation to painful stimuli that may follow damage to soft tissue containing NOCICEPTORS or injury to a peripheral nerve. Hyperalgesia can occur both at the site of tissue damage (primary hyperalgesia) and in the surrounding undamaged areas (secondary hyperalgesia). (Kandel et al., Principles of Neural Science, 3d ed, p386)
Pelvic Floor
Soft tissue formed mainly by the pelvic diaphragm, which is composed of the two levator ani and two coccygeus muscles. The pelvic diaphragm lies just below the pelvic aperture (outlet) and separates the pelvic cavity from the PERINEUM. It extends between the PUBIC BONE anteriorly and the COCCYX posteriorly.
Pelvic Organ Prolapse
Abnormal descent of a pelvic organ resulting in the protrusion of the organ beyond its normal anatomical confines. Symptoms often include vaginal discomfort, DYSPAREUNIA; URINARY STRESS INCONTINENCE; and FECAL INCONTINENCE.
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