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Uterosacral nerve ablation

Nabila Noor, Alan D Garely
Chronic pelvic pain is a commonly encountered condition that often is multifactorial. Etiologies include gynecologic, urologic, gastrointestinal, and neurologic conditions. Laboratory tests, imaging, and surgical intervention are not always helpful in identifying the etiology of pelvic pain. For appropriate management of this complex disease process, a detailed history and physical examination, and a multidisciplinary approach are needed. Pelvic pain may be caused by endometriosis, pelvic inflammatory disease, adenomyosis, interstitial cystitis/painful bladder syndrome, or other factors...
March 2015: FP Essentials
Amanda Yunker, Nila A Sathe, William Stuart Reynolds, Frances E Likis, Jeff Andrews
We synthesized the literature (articles published between 1990 and May 2011) on the treatment of noncyclic and mixed cyclic/noncyclic chronic pelvic pain (CPP) in adult women. Two reviewers assessed studies against predetermined inclusion/exclusion criteria, extracted data regarding participant and intervention characteristics and outcomes, and assigned overall quality and strength of evidence ratings. Of 2081 studies, 21 addressed surgical or nonsurgical interventions. Definitions of CPP and participant characteristics varied across studies, and most studies were of poor quality, which precluded data synthesis...
July 2012: Obstetrical & Gynecological Survey
Hossam El-Din Shawki
The aim of this work is to explore the efficacy , safety, and patients' satisfaction of laparoscopic uterosacral nerve ablation (LUNA) in relief of pain in women with chronic pelvic pain in whom diagnostic laparoscopy reveals either no pathology or mild endometriosis (AFS score ≤5). The study was a prospective, single-blind, randomized trial with 12 months follow-up. It was conducted at the endoscopy unit of the Gynecology Department of El Minia University Hospital, Egypt. One hundred ninety Egyptian women consented to participate in the study...
February 2011: Gynecological Surgery
J P Daniels, L Middleton, T Xiong, R Champaneria, N P Johnson, E M Lichten, C Sutton, P Vercellini, R Gray, R K Hills, K D Jones, G Aimi, K S Khan
BACKGROUND: There have been conflicting results in randomized trials of the effects of laparoscopic uterosacral nerve ablation (LUNA) in chronic pelvic pain. Our objective was to perform a meta-analysis using individual patient data (IPD) to provide the most comprehensive and reliable assessment of the effectiveness of LUNA. METHODS: Electronic searches were conducted in the Medline, Embase, PsycInfo and Cochrane Library databases from database inception to August 2009...
November 2010: Human Reproduction Update
Eniko Berkes, Attila Bokor, János Rigó
Surgical treatment of endometriosis aims to remove all visible areas of pelvic endometriosis and restore anatomy by division of adhesions, as well as relieve painful symptoms. In this paper, we summarize the advantages, disadvantages, and efficacy of different laparoscopic surgical procedures in the treatment of endometriosis-associated pelvic pain and infertility. Modern endometrial surgery primarily involves laparoscopy, while indication of previously widespread laparotomy has been restricted to special cases...
July 11, 2010: Orvosi Hetilap
Jane Daniels, Richard Gray, Robert K Hills, Pallavi Latthe, Laura Buckley, Janesh Gupta, Tara Selman, Elizabeth Adey, Tengbin Xiong, Rita Champaneria, Richard Lilford, Khalid S Khan
CONTEXT: Chronic pelvic pain is a common condition with a major effect on health-related quality of life, work productivity, and health care use. Operative interruption of nerve trunks in the uterosacral ligaments by laparoscopic uterosacral nerve ablation (LUNA) is a treatment option for patients with chronic pelvic pain. OBJECTIVE: To assess the effectiveness of LUNA in patients with chronic pelvic pain. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of 487 women with chronic pelvic pain lasting longer than 6 months without or with minimal endometriosis, adhesions, or pelvic inflammatory disease, who were recruited to the study by consultant gynecological surgeons from 18 UK hospitals between February 1998 and December 2005...
September 2, 2009: JAMA: the Journal of the American Medical Association
Patrick Peter Yeung, James Shwayder, Resad P Pasic
STUDY OBJECTIVE: To provide a comprehensive review of the best evidence available in the laparoscopic management of endometriosis for pain and/or fertility and to provide practical recommendations based on this information. DESIGN: Review article of randomized controlled trials. PATIENTS: Women with endometriosis. METHODS: A systematic search was performed of the Cochrane Library and MEDLINE database for randomized controlled trials relating only to laparoscopic management of endometriosis...
May 2009: Journal of Minimally Invasive Gynecology
Brittany Bettendorf, Sophie Shay, Frank Tu
Dysmenorrhea affects up to 80% of reproductive age women, in many cases causing sufficient pain to dramatically affect social and occupational roles. The prevalence varies across ethnic groups, which in part may reflect varying cultural attitudes toward women and menstruation. Key identified risk factors for dysmenorrhea include age of menarche, body mass, dietary habits, associated uterine bleeding disorders, comorbid pelvic pathology, and psychosocial problems. While much of the focus on the pathogenesis of dysmenorrhea has focused on aberrant inflammatory mediators in the uterine environment, recent studies using experimental quantitative sensory testing suggest central processing of pain is enhanced in many of these women as well, similar to both irritable bowel syndrome and painful bladder syndrome, which are closely related visceral pain disorders...
September 2008: Obstetrical & Gynecological Survey
T Xiong, J Daniels, L Middleton, R Champaneria, K S Khan, R Gray, N Johnson, E M Lichten, C Sutton, K D Jones, F-P Chen, P Vercellini, G Aimi, W-M Lui
BACKGROUND: Currently, there are a number of clinical trials, but no international collaboration for collating research on effectiveness of laparoscopic uterosacral nerve ablation (LUNA) for alleviating chronic pelvic pain. OBJECTIVE: Meta-analysis was used by collecting individual patient data (IPD) from the existing trials, to provide a comprehensive assessment of the effectiveness of LUNA that will be generalisable in various clinical contexts. METHODS: IPD will be sought and collected from all relevant (both already finished and continuing) randomised trials identified through previous systematic reviews...
December 2007: BJOG: An International Journal of Obstetrics and Gynaecology
Chi-Mou Juang, Pesus Chou, Ming-Shien Yen, Huann-Cheng Horng, Nae-Fong Twu, Chih-Yao Chen
OBJECTIVE: To evaluate the efficacy of laparoscopic uterosacral nerve (LUNA) alone vs. LUNA plus presacral neurectomy (PN) in the treatment of primary dysmenorrhea. STUDY DESIGN: Seventy-four patients were randomly allocated to LUNA alone or LUNA plus PN. Evaluation of severity of menstrual pain was based on multidimensional scoring. RESULTS: Sixty-seven patients were eligible for analysis (35 LUNA alone, 32 LUNA plus PN). Baseline demographic features were comparable between the 2 groups...
July 2007: Journal of Reproductive Medicine
P M Latthe, M L Proctor, C M Farquhar, N Johnson, K S Khan
OBJECTIVES: To assess the effectiveness of surgical interruption of pelvic nerve pathways in primary and secondary dysmenorrhea. Data sources. The Cochrane Menstrual Disorders and Subfertility Group Trials Register (9 June 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (1966 to Nov. 2003), EMBASE (1980 to Nov. 2003), CINAHL (1982 to Oct. 2003), MetaRegister of Controlled Trials, the citation lists of review articles and included trials, and contact with the corresponding author of each included trial...
2007: Acta Obstetricia et Gynecologica Scandinavica
Istyván Drozgyik, Miklós Vizer, István Szabó
OBJECTIVE: Chronic pelvic pain is a complex disease and is far more common than generally recognized. STUDY DESIGN: Between 1 January 1979 and 31 December 2002 authors had performed 11,681 laparoscopic interventions. Among them, 1061 operations (9.08%) were done because of chronic pelvic pain. RESULTS: In 29.5% of these cases no anatomical abnormality was found. Analysis of data of laparoscopic operations performed from 1989 to 1990 and from 1998 to 1999 revealed that complaints dated back for a significantly longer period of time in patients presenting no obvious sign of pelvic anatomical anomaly when compared with those who had positive findings...
August 2007: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Chi-Mou Juang, Ming-Shien Yen, Huann-Cheng Horng, Chih-Yao Cheng, Hung-Chuan Yu, Chia-Ming Chang
BACKGROUND: This pilot study was undertaken to evaluate the effect of laparoscopic uterosacral nerve ablation (LUNA) for treatment of primary deep dyspareunia. METHODS: Between July 2002 and June 2003, 12 consecutive patients diagnosed with primary deep dyspareunia were treated with the LUNA procedure. The evaluation scoring system included the Hospital Anxiety and Depression Scale and the revised Sabbatsberg Sexual Rating Scale, done at baseline and 3, 6, and 12 months after LUNA...
March 2006: Journal of the Chinese Medical Association: JCMA
Chiou-Chung Yuan
Chronic pelvic pain is a complicated syndrome comprised of different types of pain, including dysmenorrhea, deep dyspareunia, and intermenstrual pain, which can make interpretation difficult. Therefore, investigation of this complex syndrome requires very careful consideration. Accumulating data from several randomized studies, we have now come to realize that LUNA can be an option in a few circumstances, especially for control of menstrual pain without endometriosis; however, its effectiveness may not extend to other indications, such as alleviating secondary dysmenorrhea associated with endometriosis (although it could, however, be reached by presacral neurectomy)...
March 2006: Journal of the Chinese Medical Association: JCMA
Stefano Palomba, Tiziana Russo, Angela Falbo, Francesco Manguso, Pietro D'Alessandro, Alberto Mattei, Achille Tolino, Francesco Branconi, Errico Zupi, Fulvio Zullo
OBJECTIVE: To assess and compare the laparoscopic uterine nerve ablation (LUNA) and the vaginal uterosacral ligament resection (VUSR) in postmenopausal women with chronic pelvic pain (CPP). STUDY DESIGN: Eighty postmenopausal women with intractable and severe midline CPP were randomized to undergo LUNA or VUSR. Costs of two surgical procedures were assesses. Cure rate, severity of CPP, and deep dyspareunia were also evaluated after 6 and 12 months from surgery. RESULTS: The mean cost of LUNA resulted significantly higher in comparison with VURS (2078+/-637 versus 1497+/-297, P<0...
November 2006: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Chi-Mou Juang, Ming-Shien Yen, Huann-Cheng Horng, Hung-Chuan Yu, Chia-Ming Chang, Jiun-Yih Yeh
Deep dyspareunia, often described as pain resulting from pelvic thrusting during sexual intercourse, is relatively common and has many causes. To date, feasible surgical interventions for deep dyspareunia are very rare. The two procedures which have been mentioned in the literature for the treatment of deep dyspareunia were laparoscopic uterosacral ligament ablation (LUNA) and uterine ventrosuspension. We report the case of a young female patient, aged 32, gravida 3, parity 2, presenting with deep dyspareunia and primary dysmenorrhea for 4 years...
2006: Gynecologic and Obstetric Investigation
Pallavi M Latthe, David A Braunholtz, Robert K Hills, Khalid S Khan, Richard Lilford
To explore gynaecologists' 'prior' beliefs on effectiveness of laparoscopic uterosacral nerve ablation (LUNA), a structured survey was used to gather information on the distribution of their prior beliefs regarding the effects of LUNA on pelvic pain, both numerically [on a 10-point visual analogue scale] and by responses to a questionnaire. None of the 25 gynaecologists responding to the questionnaire stated that LUNA would increase pain, while two of the 25 gave numerical answers suggesting they believed that the intervention would worsen the pain...
February 2005: BJOG: An International Journal of Obstetrics and Gynaecology
P M Latthe, Rebecca J Powell, Jane Daniels, R K Hills, R Gray, J K Gupta, K S Khan
To examine the variation in current indications and surgical techniques for performing laparoscopic uterosacral nerve ablation (LUNA) in Europe, all consultants on the databases of the UK Royal College of Obstetricians and Gynaecologists (1569) and the European Society of Gynaecological Endoscopy (301) were surveyed. The questionnaire was returned by 719 (38% of 1870) of the gynaecologists contacted and 173 (24%) performed LUNA. Indications for LUNA, which included chronic pelvic pain (68%), dysmenorrhoea (66%), dyspareunia (39%) and endometriosis (60%), were similar across the United Kingdom and the rest of Europe...
August 2004: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
(no author information available yet)
BACKGROUND: Chronic pelvic pain is a common condition with a major impact on health-related quality of life, work productivity and health care utilisation. The cause of the pain is not always obvious as no pathology is seen in 40-60% of the cases. In the absence of pathology there is no established treatment. The Lee-Frankenhauser sensory nerve plexuses and parasympathetic ganglia in the uterosacral ligaments carry pain from the uterus, cervix and other pelvic structures. Interruption of these nerve trunks by laparoscopic uterosacral nerve ablation (LUNA) may alleviate pain...
December 8, 2003: BMC Women's Health
R W Shaw
There have been few appropriately conducted trials to evaluate the effectiveness of laser destruction of endometriosis in relieving pain symptoms, yet the techniques are increasingly being used. Laser destruction has been shown to be more effective than the placebo effect of laparoscopy alone in one trial, at least at 6-month follow-up. Longer-term studies suggest increasing recurrence of symptoms with time [23% at 12 months in one study, and 44% by a mean of 19.7 months (5-60) follow-up]. These recurrence rates are similar to those seen following 6 months medical treatment...
November 2003: Annals of the New York Academy of Sciences
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