Assessment of pelvic floor muscles in women with deep endometriosis.

PURPOSE: To assess function and prevalence of spasms and trigger points of the pelvic floor muscles in women with deep endometriosis. METHODS: One hundred and four (104) patients were assessed. Group 1 (G1) was composed of 52 subjects diagnosed with deep endometriosis proven by magnetic resonance imaging (MRI); Group 2 (G2) was composed of 52 women with no signs of endometriosis. Subjects from both G1 and G2 were seen at the Division of Pelvic Pain and Endometriosis and at Center for Prevention of Sexually Transmitted Diseases, both at Federal University of São Paulo (UNIFESP), respectively. A full physical therapy evaluation was carried out, including medical history, presence of dyspareunia and physical examination, which included detailed evaluation of pelvic floor muscles and occurrence of muscle spasm, trigger point and muscle function. RESULTS: The average age of the subjects in the study group was 36.4 and 30.9 years in the control group (p = 0.002). A greater prevalence of deep dyspareunia was found in the subjects in the endometriosis group when compared to the control group (p = 0.010). Women in G1 had higher prevalence of muscle spasms. In this group, 53.9 % had spasms-compared to only 17.3 % of women in G2 (p < 0.001). On the other hand, no significant difference between the groups (p = 0.153) was found while searching for the presence of trigger points. CONCLUSION: Women with deep endometriosis have increased prevalence of pelvic floor muscle spasms when compared to the control group.

Vascular entrapment of the sciatic plexus causing catamenial sciatica and urinary symptoms.

AIM OF THE VIDEO / INTRODUCTION: Pelvic congestion syndrome is a well-known cause of cyclic pelvic pain (Ganeshan et al., Cardiovasc Intervent Radiol 30(6):1105-11, 2007). What is much less well known is that dilated or malformed branches of the internal or external iliac vessels can entrap the nerves of the sacral plexus against the pelvic sidewalls, producing symptoms that are not commonly seen in gynecological practice, such as sciatica, or refractory urinary and anorectal dysfunction (Possover et al., Fertil Steril 95(2):756-8. 2011). The objective of this video is to explain and describe the symptoms suggestive of vascular entrapment of the sacral plexus, as well as the technique for the laparoscopic decompression of these nerves. METHOD: Two anecdotal cases of intrapelvic vascular entrapment are used to review the anatomy of the lumbosacral plexus and demonstrate the laparoscopic surgical technique for decompression at two different sites, one on the sciatic nerve and one on the sacral nerve roots. RESULT: After surgery, the patient with the sciatic entrapment showed full recovery of the sciatica and partial recovery of the myofascial pain. The patient with sacral nerve root entrapment showed full recovery with resolution of symptoms. CONCLUSION: The symptoms suggestive of intrapelvic nerve entrapment are: perineal pain or pain irradiating to the lower limbs in the absence of a spinal disorder, and lower urinary tract symptoms in the absence of prolapse of a bladder lesion. In the presence of such symptoms, the radiologist should provide specific MRI sequences of the intrapelvic portion of the sacral plexus and a team and equipment to expose and decompress the sacral nerves should be prepared.

Sacral nerve infiltrative endometriosis presenting as perimenstrual right-sided sciatica and bladder atonia: case report and description of surgical technique.

Endometriosis infiltrating the sacral nerve roots is a rarely reported manifestation of the disease. The objectives of this article are to report such a case and to describe the surgical technique for laparoscopic decompression of sacral nerve roots and treatment of endometriosis at this site. The patient as a 38-year-old woman who had undergone 2 previous laparoscopic procedures for electrocoagulation of peritoneal endometriosis and self-reported perimenstrual right-sided sciatica and urinary retention. Clinical examination revealed allodynia (pain from a stimulus that does not normally cause pain) on the S2 to S4 dermatomes and hypoesthesia on part of the S3 dermatome. Magnetic resonance imaging showed an endometriotic nodule infiltrating the anterior rectal wall. Laparoscopic exploration of the sacral nerve roots demonstrated vascular compression of the lumbosacral trunk and endometriosis entrapping the S2 to S4 sacral nerve roots, with an endometrioma inside S3. The endometriosis was removed from the sacral nerve roots and detached from the sacral bone, and a nodulectomy of the anterior rectal wall was performed. Normal urinary function was restored on postoperative day 2, and pain resolved after a period of post-decompression. Intrapelvic causes of entrapment of sacral nerve roots are rarely described in the current literature, either because of misdiagnosis or actual rareness of the condition. Recognition of the clinical markers for these lesions may lead to an increase in diagnosis and specific treatment.

Sintomas urinários pós-histerectomia radical: revisão de literatura e análise de dados / Urinary symptons after radical hysterectomy: bibliographic review and analysis of data

O carcinoma do colo uterino representa um importante problema de saúde pública. Mundialmente é a quarta maior causa de mortes por câncer, e no Brasil é a neoplasia mais frequente do trato genital feminino, sendo a segunda maior causa de morte por câncer em mulheres e a primeira de morte em mulheres em idade reprodutiva. Uma das formas de tratamento é a histerectomia radical, sendo que neste tratamento 70 por cento das mulheres apresentam disfunção vesical após o procedimento. O objetivo do estudo foi analisar a relação de sintomas urinários pós-cirurgia. Foi realizado levantamento bibliográfico com publicações entre os anos de 1997 a 2007. Percebeu-se que sintomas urinários são cada vez mais frequentes após histerectomia radical e entre as causas a mais provável é a lesão nervosa durante o procedimento, prejudicando ainda mais a qualidade de vida destas pacientes. Sabendo-se disto, é de fundamental importância o acompanhamento multidisciplinar destas doentes, incluindo-se nesta equipe o fisioterapeuta, o qual poderá contribuir significantemente no tratamento proposto.

The carcinoma of the uterine cervix is a great public health problem. In the world, it is the fourth leading cause of cancer deaths and in Brazil, it is the most common cancer of the female genital tract, and the second cause of cancer deaths in women and the first of death in women at reproductive age. One of the treatment methods is the radical hysterectomy. In this treatment, 70 percent of women present bladder dysfunction after surgery. The objective of the study was to examine the relation of urinary symptoms after radical hysterectomy for cancer of the cervix, and to examine the causes of the presence of urinary symptoms after surgery. The bibliographic survey was done on publications between the years of 1997 and 2007. It is possible to emphasize that urinary symptoms are increasingly frequent after radical hysterectomy. The disease itself undermines the physical, psychological and social well-being of the patient, and after the withdrawal of the uterus other consequences may appear, further damaging the quality of life of these patients. Bearing this in mind, it is a fundamental importance multidisciplinary monitoring of these patients, including in this team the physical therapist, who could contribute significantly in the proposed treatment.