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1.
Urologiia ; (2): 46-50, 2021 May.
Artigo em Russo | MEDLINE | ID: mdl-33960156

RESUMO

OBJECTIVE: to study the effectiveness of methods of endovascular treatment of May-Turner syndrome and nutcracker syndrome as a cause of varicose veins of the pelvis in men with chronic pelvic pain syndrome. MATERIALS AND METHODS: a comprehensive examination was carried out in 445 men with chronic pelvic pain syndrome. The patients age ranged from 20 to 68 years (mean age 39.5 years). The diagnosis of varicose veins of the pelvis was established in 49 patients, of which 25 had primary varicose veins of the pelvis, in 24 - secondary varicose veins of the pelvis (13 patients with May-Turner syndrome, 11 patients with nutcracker syndrome). The patients with the nutcracker syndrome underwent embolization of the testicular and pelvic veins using the combined sandwich technique. Patients with May-Turner syndrome underwent stenting of the left common iliac vein. RESULTS: In order to assess the technical efficiency of endovascular treatment, control ultrasound was performed at 1, 3, 6 and 12 months. In 100% of cases, throughout the observation period, the patency of venous stents was maintained; in all cases of embolization of the left testicular vein, there was no blood flow in the embolized vein. In order to assess the clinical efficacy of endovascular treatment after 1, 3, 6, 9 and 12 months. after it, patients were questioned using the NIH-CPSI scale and VAS. The most significant changes in clinical manifestations and ultrasound data were observed after 3 months. after endovascular treatment. CONCLUSIONS: Balloon angioplasty and iliac vein stenting in May-Turner syndrome and left gonadal vein embolization in nutcracker syndrome are minimally invasive treatments with a favorable patient safety profile.


Assuntos
Dor Crônica , Embolização Terapêutica , Varizes , Adulto , Idoso , Dor Crônica/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pélvica/diagnóstico por imagem , Dor Pélvica/etiologia , Dor Pélvica/terapia , Pelve/diagnóstico por imagem , Flebografia , Resultado do Tratamento , Varizes/complicações , Varizes/diagnóstico por imagem , Varizes/cirurgia , Adulto Jovem
2.
Reprod Health ; 18(1): 109, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34049572

RESUMO

BACKGROUND: Pelvic inflammatory disease (PID) is the inflammation of the adnexa of the uterus, that mainly manifests in a subclinical/chronic context and goes largely underreported. However, it poses a major threat to women's health, as it is responsible for infertility and ectopic pregnancies, as well as chronic pelvic pain. Previous studies in Jordan have not reported PID, attributed mainly to the social structure of the country which largely represents a sexually conservative population. Our study aims to report the clinical symptoms that point towards PID and investigate the major risk determinants for the Jordanian population, in a cross-sectional study, using our scoring system based only on clinical data and examination. METHODS: One hundred sixty-eight consecutive adult women that came in the Outpatient Clinics of Gynaecological Department of the Jordan University Hospital were interviewed and their medical history and symptoms were registered and analysed. A Score for PID symptoms, we developed, was given to each woman. Results and correlations were then statistically tested. RESULTS: Our study population consisted of relatively young women (37.7 ± 11) that had their first child at an average age of 24.1 (± 4.8) and a mean parity of 3.1 (± 2.2). Fifty-eight women (34.5%) reported having undergone at least one CS, while the mean PID Symptom Score was 3.3 (± 2.3). The women in our study exhibited 8 symptoms of PID, namely dysmenorrhea and vaginal discharge; being the commonest (45.2% and 44.6% respectively), in addition to chronic pelvic pain, pelvic heaviness, menorrhagia, dyspareunia, urinary symptoms, and smelly urine. They also reported history of 3 conditions that can be attributed to PID, that is infertility, preterm labour, and miscarriages. CONCLUSIONS: Our PID Scoring System seems to identify the risk factors of PID and predict well the PID likelihood. This score predicts that women with higher parity, who used contraceptives and underwent any invasive medical procedure are expected to score higher in the PID Symptom Score. Our data also suggest that PID should not be ruled out in the Jordanian population when symptoms are compatible to this diagnosis.


Assuntos
Anticoncepcionais/efeitos adversos , Infertilidade Feminina/microbiologia , Doença Inflamatória Pélvica/epidemiologia , Dor Pélvica/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Infertilidade Feminina/epidemiologia , Jordânia/epidemiologia , Doença Inflamatória Pélvica/complicações , Dor Pélvica/etiologia , Gravidez , Prevalência , Fatores de Risco , Comportamento Sexual , Saúde da Mulher , Adulto Jovem
3.
Pan Afr Med J ; 38: 154, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33995761

RESUMO

Mammary myofibroblastoma is a rare soft-tissue tumor. Extramammary myofibroblastomas are particularly rare. We here report the case of a 78-year-old man presenting with pelvic pain relieved by defecation or urination. Rectal examination showed a mass in front of the anterior rectal wall. The magnetic resonance imaging (MRI) showed a well-circumscribed and heterogeneous mass measuring 10 x 6 x 8cm located behind the bladder which was pushed forward in front of the rectosigmoid. Immunohistochemical analyses showed diffuse co-expression on CD34 cells and desmin, Rb expression on most cells, oestrogen receptor expression, intense and diffuse P16 expression and a ki67 proliferation index of 25%. The patient had no recurrence 8 months after radiotherapy followed by surgery. Breast myofibroblastoma is a rare and benign tumor. Recurrence is hardly observed after local treatment. This study highlights the supporting role of radiotherapy in the efficacy of surgery.


Assuntos
Neoplasias de Tecido Muscular/diagnóstico , Neoplasias Pélvicas/diagnóstico , Dor Pélvica/etiologia , Idoso , Terapia Combinada , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias de Tecido Muscular/patologia , Neoplasias de Tecido Muscular/terapia , Neoplasias Pélvicas/patologia , Neoplasias Pélvicas/terapia
4.
Zhongguo Zhen Jiu ; 41(4): 395-9, 2021 Apr 12.
Artigo em Chinês | MEDLINE | ID: mdl-33909360

RESUMO

OBJECTIVE: To observe the effect of electroacupuncture (EA) on chronic pelvic pain in patients with sequelae of pelvic inflammatory disease. METHODS: A total of 144 patients with chronic pelvic pain were randomly divided into an observation group (72 cases, 10 cases dropped off) and a control group (72 cases, 9 cases dropped off). The patients in the control group were treated with ibuprofen sustained-release capsules 10 days before menstruation, 0.3 g each time, once a day. On the basis of the treatment of the control group, the patients in the observation group were treated with EA at Guanyuan (CV 4), Shuidao (ST 28), Guilai (ST 29), Shenshu (BL 23) and Ciliao (BL 32), disperse-dense wave, 2 Hz/15 Hz of frequency, once a day. The patients in both groups were treated for 10 days per menstrual cycle for 3 menstrual cycles. The visual analogue scale (VAS) scores of lower abdomen and lumbosacral area, local sign score, quality of life scale score and pain disappearance rate were compared between the two groups before and after treatment. RESULTS: The VAS scores of lower abdomen and lumbosacral area as well as each item score and total score of local signs in the observation group after treatment were significantly lower than those before treatment and those in the control group (P<0.05). Compared before treatment, the scores of physiological, psychological, social and environmental domains of the quality of life scale in the observation group were significantly increased after treatment (P<0.05); the score of physiological domain in the control group after treatment was significantly higher than that before treatment (P<0.05); the score of physiological domain in the observation group was higher than that in the control group (P<0.05). The pain disappearance rate was 87.1% (54/62) in the observation group, which was higher than 46.0% (29/63) in the control group (P<0.05). CONCLUSION: EA can relieve the pain symptoms in patients with chronic pelvic pain and improve their quality of life.


Assuntos
Eletroacupuntura , Doença Inflamatória Pélvica , Pontos de Acupuntura , Analgésicos , Feminino , Humanos , Doença Inflamatória Pélvica/complicações , Doença Inflamatória Pélvica/terapia , Dor Pélvica/etiologia , Dor Pélvica/terapia , Qualidade de Vida
5.
BMC Womens Health ; 21(1): 181, 2021 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-33906668

RESUMO

BACKGROUND: Due to the scarcity of adequately powered, randomized controlled trials and internationally standardized diagnostic criteria, evidence on the diagnosis and treatment of pelvic congestion syndrome (PCS) is limited. Earlier epidemiologic observations led to the attribution of PCS to the premenopausal state, and a remission of symptoms after menopause is frequently described a hallmark of the pathology. This concept has currently been challenged by radiological studies reporting a notable prevalence of ovarian venous congestion in adult female patients of advanced age. PCS as a pathology of postmenopausal women, however, has not been acknowledged by systematic research to date, impeding appropriate diagnostics and therapy for affected patients. CASE PRESENTATION: A 69-year-old postmenopausal patient presented with newly diagnosed dilated and insufficient pelvic veins in combination with characteristic pain anamnesis, thereby fulfilling the diagnostic criteria of PCS. Interventional coil embolization of both ovarian veins as a standard treatment previously described for premenopausal patients was successfully performed, resulting in prompt alleviation of symptoms. The patient remained symptom-free at the 18-month follow-up visit. CONCLUSIONS: Given this first systematically documented case of a patient with postmenopausal symptomatic PCS in the light of recently published data on the prevalence of ovarian venous congestion in patients of advanced age, it may be assumed that PCS is not to be considered a pathology strictly limited to premenopausal state. Further clinical studies expanding the diagnostic scope beyond menopause may help to substantiate evidence and subsequently define standardized therapeutic approaches for affected postmenopausal patients.


Assuntos
Dor Crônica , Embolização Terapêutica , Varizes , Adulto , Idoso , Feminino , Humanos , Dor Pélvica/etiologia , Pelve , Pós-Menopausa , Varizes/complicações , Varizes/terapia
7.
Schmerz ; 35(3): 159-171, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-33704582

RESUMO

BACKGROUND: Endometriosis is associated with various types of intense pain. In addition to nociceptive pain, there is also a nociplastic reaction with central sensitization. Atypical symptoms such as acyclic lower abdominal pain, radiating pain, non-specific bladder and intestinal complaints or even depression are frequent as are classic cyclical complaints such as severe dysmenorrhea, cyclical lower abdominal pain, dyspareunia, dysuria and dyschezia. In cases of a diverse range of symptoms, patients often consult not just gynecologists but specialists from other disciplines (e.g., internal medicine, gastroenterology, orthopedics, pain therapy, psychology). AIMS: Overview about the pathophysiology and complexity of the disease and the resulting treatment options. A multimodal interdisciplinary concept might be able to take into consideration all aspects of the complex disease. METHODS: Interdisciplinary concepts should be involved in the treatment of endometriosis patients along with hormonal and surgical therapy, which are generally under the supervision of a gynecologist. Pain management, dietary changes, psychological support, as well as physiotherapy should be included. The present article is intended to provide an overview of possible treatment strategies for chronic, symptomatic endometriosis. CONCLUSION: The use of multimodal treatment strategies regarding the complex pathophysiological aspects of this disease might be helpful in significantly improving the quality of life of endometriosis patients.


Assuntos
Dispareunia , Endometriose , Constipação Intestinal , Dismenorreia , Dispareunia/etiologia , Dispareunia/terapia , Endometriose/terapia , Feminino , Humanos , Dor Pélvica/etiologia , Dor Pélvica/terapia , Qualidade de Vida
8.
BMC Musculoskelet Disord ; 22(1): 237, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33648489

RESUMO

BACKGROUND: Many women develop pelvic girdle pain (PGP) during pregnancy and about 10% have chronic pain several years after delivery. Self-administered pain provocation tests are one way to diagnose and evaluate this pain. Their validity in post-partum women is not yet studied. The purpose of this study was to evaluate the validity of self-administered test for assessment of chronic pregnancy-related PGP several years after delivery. METHODS: Women who previously have had PGP during pregnancy and who participated in one of three RCT studies were invited to a postal follow up of symptoms including performance of self-administered tests after two, 6 or 11 years later, respectively. In total, 289 women returned the questionnaire and the test-results. Of these, a sub-group of 44 women with current PGP underwent an in-person clinical examination. Comparisons were made between test results in women with versus without PGP but also, in the sub-group, between the self-administered tests and those performed during the clinical examination. RESULTS: Fifty-one women reported PGP affecting daily life during the last 4 weeks, and 181 reported pain when performing at least one of the tests at home. Those with chronic PGP reported more positive tests (p < 0.001). There was no significant difference between diagnosis from the self-administered tests compared to tests performed during the in-person clinical examination (p = 0.305), either for anterior or posterior PGP. There were no significant differences of the results between the tests performed self-administered vs. during the clinical examination. CONCLUSION: A battery of self-administered tests combined with for example additional specific questions or a pain-drawing can be used as a screening tool to diagnose chronic PGP years after delivery. However, the modified SLR test has limitations which makes its use questionable.


Assuntos
Dor Crônica , Dor da Cintura Pélvica , Complicações na Gravidez , Dor Crônica/diagnóstico , Dor Crônica/epidemiologia , Feminino , Humanos , Medição da Dor , Dor da Cintura Pélvica/diagnóstico , Dor da Cintura Pélvica/epidemiologia , Dor Pélvica/diagnóstico , Dor Pélvica/epidemiologia , Dor Pélvica/etiologia , Período Pós-Parto , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia
9.
BMC Pregnancy Childbirth ; 21(1): 219, 2021 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-33736613

RESUMO

BACKGROUND: Lumbopelvic pain (LPP) is common during pregnancy and can have long-lasting negative consequences in terms of disability and reduced quality of life. Therefore, it is crucial to identify women at risk of having pregnancy-related LPP after childbirth. This study aimed to investigate the association between body perception, pain intensity, and disability in women with pregnancy-related LPP during late pregnancy and postpartum, and to study whether a disturbed body perception during late pregnancy predicted having postpartum LPP. METHODS: A prospective cohort study in 130 primiparous women (median age = 30 years) was performed. Pain intensity, disability, and lumbopelvic body perception during the last month of pregnancy and 6 weeks postpartum were assessed with the Numerical Pain Rating Scale (NPRS), Oswestry Disability Index, and Fremantle Back Awareness Questionnaire, respectively. Having pregnancy-related LPP was defined as an NPRS score ≥ 1/10. At both timepoints, women were categorized into three groups; pain-free, LPP with low disability, and LPP with high disability (based on Oswestry Disability Index scores). At each timepoint, body perception was compared between groups, and correlations between body perception, pain intensity, and disability were evaluated in women with LPP by using non-parametric tests. Logistic regression analysis was used to determine whether body perception during the last month of pregnancy predicted the presence of LPP 6 weeks postpartum. RESULTS: Women with LPP at the end of pregnancy, and 6 weeks postpartum reported a more disturbed body perception compared to pain-free women (p ≤ 0.005). Greater body perception disturbance correlated with higher pain intensity (σ = 0.266, p = 0.008) and disability (σ = 0.472, p < 0.001) during late pregnancy, and with pain intensity 6 weeks postpartum (σ = 0.403, p = 0.015). A disturbed body perception during late pregnancy nearly significantly predicted having postpartum LPP (Odds Ratio = 1.231, p = 0.052). CONCLUSIONS: Body perception disturbance was greater in women experiencing LPP during late pregnancy and postpartum compared to pain-free women, and correlated with pain intensity and disability. Though non-significant (p = 0.052), the results of the regression analysis suggest that greater body perception disturbance during late pregnancy might predict having LPP postpartum. However, future studies should follow up on this.


Assuntos
Autoavaliação Diagnóstica , Dor Lombar , Medição da Dor , Dor Pélvica , Período Pós-Parto , Complicações na Gravidez , Qualidade de Vida , Adulto , Estudos de Coortes , Avaliação da Deficiência , Feminino , Humanos , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Dor Lombar/psicologia , Paridade , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Dor Pélvica/psicologia , Período Pós-Parto/fisiologia , Período Pós-Parto/psicologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/psicologia , Estudos Prospectivos
11.
Zhongguo Zhen Jiu ; 41(1): 31-5, 2021 Jan 12.
Artigo em Chinês | MEDLINE | ID: mdl-33559439

RESUMO

OBJECTIVE: To compare the therapeutic effect between acupuncture combined with ibuprofen sustained-release capsule and simple ibuprofen sustained-release capsule on chronic pelvic pain (CPP) after pelvic inflammatory disease (PID). METHODS: A total of 144 patients were randomized into an observation group (72 cases, 10 cases dropped off) and a control group (72 cases, 9 cases dropped off). Ibuprofen sustained-release capsule was given orally in the control group, one capsule a time. On the basis of the treatment in the control group, acupuncture was applied at Guanyuan (CV 4), Shuidao (ST 28), Guilai (ST 29), Shenshu (BL 23) and Ciliao (BL 32), and Shuidao (ST 28), Guilai (ST 29), Shenshu (BL 23) and Ciliao (BL 32) were connected to electroacupuncture in the observation group. The treatment was given 10 days before menstruation, once a day for 3 menstrual cycles in both groups, and the follow-up was adopted 3 menstrual cycles after treatment. The visual analogue scale (VAS) scores of hypogastrium and lumbosacral region before treatment, after treatment, and at the follow-up, the score of local signs and the score of World Health Organization quality of life questionnaire-brief version (WHOQOL-BREF) before and after treatment were observed in the both groups. RESULTS: After treatment and at the follow-up, the VAS scores of hypogastrium and lumbosacral region were decreased compared before treatment in both groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). After treatment, except for the score of uterosacral ligament tenderness in the control group, the scores of local signs were decreased compared before treatment in both groups (P<0.05), and the score of uterine appendages tenderness, the total score of local signs in the observation group were lower than the control group (P<0.05). Compared before treatment, the physiological scores of WHOQOL-BREF were increased in both groups (P<0.05), the scores of psychology, social relations and environment were increased in the observation group (P<0.05), and the physiological score was higher than the control group (P<0.05). CONCLUSION: Acupuncture combined with ibuprofen sustained-release capsule can effectively improve the symptoms, signs and quality of life in patients with CPP after PID, the therapeutic effect is superior to simple ibuprofen sustained-release capsule.


Assuntos
Terapia por Acupuntura , Doença Inflamatória Pélvica , Pontos de Acupuntura , Feminino , Humanos , Doença Inflamatória Pélvica/tratamento farmacológico , Doença Inflamatória Pélvica/etiologia , Dor Pélvica/tratamento farmacológico , Dor Pélvica/etiologia , Qualidade de Vida , Resultado do Tratamento
12.
Medicine (Baltimore) ; 100(4): e23916, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530191

RESUMO

BACKGROUND: Chronic pelvic pain (CPP) is one of the common sequela of pelvic inflammatory disease, the pathological factors are adhesions, scarring and pelvic congestion which caused by inflammation, often cause abdominal pain and lumbosacral soreness, and aggravated after fatigue, sexual intercourse and during menstruation. It is difficult to treat because special pathological changes. Although acupuncture has gained increased popularity for the management of CPP, evidence regarding its efficacy is lacking. Therefore, a systematic review of acupuncture for chronic pelvic pain in patients with SPID is required to provide available evidence for further study. METHODS AND ANALYSIS: We will conduct a systematic review of randomized controlled trials (RCTs) that investigate the effect and safety of acupuncture for the treatment of chronic pelvic pain patients with SPID. We will electronically search the literature in the databases of PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, the Web of Science, China National Knowledge Infrastructure (CNKI), Wan-fang Digital Periodicals, Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP) and select eligible articles. Data extraction will be conducted by 2 researchers independently, and risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. The primary outcomes will be total effective rate and VAS pain score, and the secondary outcomes include the recurrence rate and adverse reaction. All data analysis will be conducted by software Review Manager V.5.3. RESULTS: This study will provide the latest analysis of the currently available evidence for the efficacy of acupuncture for chronic pelvic pain in patients with SPID. PROSPERO REGISTRATION NUMBER: CRD42020193826.


Assuntos
Terapia por Acupuntura , Dor Crônica/terapia , Metanálise como Assunto , Doença Inflamatória Pélvica/complicações , Dor Pélvica/terapia , Revisões Sistemáticas como Assunto , Dor Crônica/etiologia , Protocolos Clínicos , Feminino , Humanos , Dor Pélvica/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
13.
Medicine (Baltimore) ; 100(6): e24597, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578561

RESUMO

ABSTRACT: Adenomyosis and endometriosis are common causes of pelvic pain in women of reproductive age. Furthermore, adenomyosis is a major cause of menorrhagia. This study aimed to evaluate the effects of Etonogestrel implants on pelvic pain and menstrual flow in women requiring long-acting reversible contraception and suffering from adenomyosis or endometriosis.One hundred women with adenomyosis or endometriosis and asking for contraception with Etonogestrel implants were enrolled in this study and were followed-up for 24 months. Patients were interviewed on pelvic pain by visual analog scale (VAS) pain score, menstrual flow by the number of sanitary napkins, menstrual bleeding pattern, weight gain, breast pain, and any other treatment side effects.Seventy four patients who were treated with Etonogestrel implants completed the 24-month follow-up in which we found a significant decrease in pelvic pain VAS scores comparing baseline scores to 6, 12, and 24 months (baseline: 6.39 ±â€Š2.35 to 24-month: 0.17 ±â€Š0.69, P < 0.05). The menstrual volume decreased significantly compared with that at baseline ((40.69 ±â€Š30.92) %, P < 0.05). However, vaginal bleeding, amenorrhea, weight gain, and acne occurred after treatment in some patients.Etonogestrel implants were effective in reducing pelvic pain and menstrual flow of adenomyosis or endometriosis.


Assuntos
Adenomiose/tratamento farmacológico , Contraceptivos Hormonais/administração & dosagem , Desogestrel/administração & dosagem , Endometriose/tratamento farmacológico , Menorragia/tratamento farmacológico , Dor Pélvica/tratamento farmacológico , Adenomiose/complicações , Adulto , Implantes de Medicamento , Endometriose/complicações , Feminino , Humanos , Contracepção Reversível de Longo Prazo , Menorragia/etiologia , Pessoa de Meia-Idade , Dor Pélvica/etiologia , Estudos Prospectivos , Adulto Jovem
14.
Aust N Z J Obstet Gynaecol ; 61(2): E6-E11, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33386748

RESUMO

BACKGROUND: Persistent pelvic pain affects between 10-20% of women with a significant impact on their physical and mental health, sexual relationships, families and society. Estimates of the cost to women and the community is over $9 billion/annum. Although endometriosis is considered a leading cause of pelvic pain, no symptoms reliably allow the identification of those with and without endometriosis. Furthermore, the significance of mild endometriosis is now debated. The optimal clinical approach for pelvic pain and endometriosis remains unclear, with increasing evidence of other contributing factors such as central sensitisation. Studies to date have significant limitations due to their sample size, relatively short follow-up, and inclusion of only women with laparoscopically identified endometriosis. AIMS: To undertake a real-world study of women referred with pain to gynaecology outpatients of a women's hospital and explore factors influencing three-year outcomes. MATERIALS AND METHODS: Five hundred women will be randomised to one of two gynaecology units. The units will provide routine clinical care but their approaches to management of women with pelvic pain and endometriosis differ: one with skilled endoscopic gynaecologists has greater emphasis on surgery, the other, gynaecologists have more medical expertise in managing pain and menstrual problems. Participants will complete six-monthly questionnaires regarding pain and quality of life for three years. This information will not be available to clinicians. Their medical care will be followed from their medical records. The cost of outpatient care and admissions will be calculated. Data will be analysed using STATA software with appropriate post hoc tests. Australian and New Zealand Clinical Trials Registry (ANZCTR:ACTRN12616000150448).


Assuntos
Endometriose , Qualidade de Vida , Austrália , Endometriose/complicações , Feminino , Hospitais Públicos , Humanos , Nova Zelândia/epidemiologia , Dor Pélvica/etiologia
15.
Hum Reprod ; 36(2): 349-357, 2021 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-33491057

RESUMO

STUDY QUESTION: Do adenomyosis phenotypes such as external or internal adenomyosis, as diagnosed by MRI, have the same clinical characteristics? SUMMARY ANSWER: External adenomyosis was found more often in young and nulliparous women and was associated with deep infiltrating endometriosis, whereas, in contrast, internal adenomyosis was more often associated with heavy menstrual bleeding (HMB) but no differences were noted in terms of pain symptoms. WHAT IS KNOWN ALREADY: Adenomyosis is characterized by the presence of endometrial glands and stroma deep within the myometrium, giving rise to dysmenorrhea, pelvic pain and menorrhagia. Various forms have been described, including adenomyosis of the outer myometrium (external adenomyosis), which corresponds to lesions separated from the junctional zone (JZ), and adenomyosis of the inner myometrium (internal adenomyosis), which is mostly characterized by endometrial implants scattered throughout the myometrium and enlargement of the JZ. Although the pathogenesis of adenomyosis is not clearly understood, several lines of evidence suggest that these two phenotypes could have distinct origins. The clinical presentation of different forms of adenomyosis in patients warrants further investigation. STUDY DESIGN, SIZE, DURATION: This was an observational study that used data collected prospectively in non-pregnant patients aged between 18 and 42 years who had undergone surgical exploration for benign gynecological conditions at our institution between May 2005 and May 2018. Only women with a pelvic MRI performed by a senior radiologist during the preoperative work-up were retained for this study. For each patient, a standardized questionnaire was completed during a face-to-face interview conducted by the surgeon in the month preceding the surgery. The women's histories (notably their age, gravidity, history of surgery and associated endometriosis), as well as clinical symptoms such as the pain intensity, presence of menorrhagia and infertility, were noted. PARTICIPANTS/MATERIALS, SETTING, METHODS: A pelvic MRI was performed in 496 women operated at our center for a benign gynecological disease who had provided signed informed consent. Of these, 248 women had a radiological diagnosis of adenomyosis. Based on the MRI findings, the women were diagnosed as having external and/or internal adenomyosis. The women were allocated to two groups according to the adenomyosis phenotype (only external adenomyosis vs only internal adenomyosis). Women exhibiting an association of both adenomyosis forms were analyzed separately. MAIN RESULTS AND THE ROLE OF CHANCE: In all, following the MRI findings, 109 women (44.0%) exhibited only external adenomyosis, while 78 (31.5%) had only internal adenomyosis. The women with external adenomyosis were significantly younger (mean ± SD; 31.9 ± 4.6 vs 33.8 ± 5.2 years; P = 0.006), more often nulligravid (P ≤ 0.001) and more likely to exhibit an associated endometriosis (P < 0.001) compared to the women in the internal adenomyosis group. Moreover, the women exhibiting internal adenomyosis significantly more often had a history of previous uterine surgery (P = 0.002) and HMB (62 (80%) vs 58 (53.2%), P < 0.001) compared to the women with external adenomyosis. No differences in the pain scores (i.e. dysmenorrhea, non-cyclic pelvic pain and dyspareunia) were observed between the two groups. LIMITATIONS, REASONS FOR CAUTION: The exclusive inclusion of surgical patients could constitute a possible selection bias, as the women referred to our center may have suffered from particularly severe clinical symptoms. WIDER IMPLICATIONS OF THE FINDINGS: Further studies are needed to explore the pathogenesis by which these types of adenomyosis occur. This could help with the development of new treatment strategies specific for each entity. STUDY FUNDING/COMPETING INTEREST(S): none. TRIAL REGISTRATION NUMBER: N/A.


Assuntos
Adenomiose , Endometriose , Adenomiose/diagnóstico por imagem , Adolescente , Adulto , Dismenorreia/etiologia , Endometriose/complicações , Endometriose/diagnóstico por imagem , Feminino , Humanos , Miométrio/diagnóstico por imagem , Dor Pélvica/etiologia , Adulto Jovem
18.
Curr Urol Rep ; 22(2): 12, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33447905

RESUMO

PURPOSE OF REVIEW: Chronic scrotal content pain (CSCP) is a complex condition with multiple etiologies that requires a thorough understanding of its pathophysiology, workup, and treatment options. We performed a comprehensive and contemporary review to augment our current understanding of CSCP. RECENT FINDINGS: We discuss new advances in CSCP-specific pain questionnaires, modern studies of microscopic spermatic cord denervation and its variations, and novel techniques including electric nerve stimulation and cryoablation in addition to randomized control trials with significant negative findings. We also present literature focusing on the prevention of CSCP secondary to surgical iatrogenic causes. The constantly evolving literature of CSCP has led to the significant evolution in its diagnosis and treatment, from oral medications to salvage options after microscopic spermatic cord denervation. With each advance, we come closer to developing a more thorough, evidence-based algorithm to guide urologists in treatment of CSCP.


Assuntos
Dor Crônica/terapia , Doenças dos Genitais Masculinos/terapia , Escroto , Algoritmos , Dor Crônica/etiologia , Criocirurgia , Denervação/métodos , Terapia por Estimulação Elétrica , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/etiologia , Humanos , Doença Iatrogênica/prevenção & controle , Masculino , Microcirurgia , Medição da Dor , Dor Pélvica/etiologia , Dor Pélvica/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Dermatopatias/diagnóstico , Dermatopatias/etiologia , Dermatopatias/terapia , Cordão Espermático/inervação , Doenças Testiculares/diagnóstico , Doenças Testiculares/terapia
19.
BMC Womens Health ; 21(1): 19, 2021 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413295

RESUMO

BACKGROUND: Women with endometriosis are commonly treated by their sole provider. In this single-provider model of care, women frequently report long diagnostic delays, unresolved pelvic pain, multiple laparoscopic surgeries, sequential consultations with numerous providers, and an overall dissatisfaction with care. The emergence of multidisciplinary endometriosis centers aims to reduce diagnostic delays, improve pain management, and promote patient satisfaction; however, baseline data at the time of presentation to a multidisciplinary center are lacking. METHODS: A real-world, retrospective, single-site, cross-sectional study of women with surgically confirmed and/or clinically diagnosed endometriosis generated baseline data for a planned longitudinal assessment of multidisciplinary care of endometriosis. The primary objective was to determine the proportion of patients experiencing mild, moderate, or severe pain for dysmenorrhea, non-menstrual pelvic pain (NMPP), and dyspareunia at entry into a multidisciplinary endometriosis clinic. Also explored were relationships between pain scores and clinical endpoints obtained from electronic medical records. RESULTS: More than half (59%) of the study participants (n = 638) reported experiencing pelvic pain for ≥ 5 years. Pain intensity was highest for patients reporting dysmenorrhea, followed by NMPP, and dyspareunia. Significant correlations were observed between total pelvic pain and patient age (r = -0.22, p < 0.001, n = 506) and number of previous healthcare providers (r = 0.16, p = 0.006, n = 292); number of previous providers and duration of pain (r = 0.21, p = < 0.0001, n = 279); and duration of pain and years since diagnosis (r = 0.60, p < 0.001, n = 302). Mean pain scores differed significantly by age group for dysmenorrhea (p < 0.001), NMPP (p = 0.005), and total pelvic pain (p < 0.001), but not for dyspareunia (p = 0.06), with the highest mean pain scores reported among those < 30 years of age. CONCLUSION: These real-world data indicate that in the single-provider model of care, unresolved pelvic pain is common among women with endometriosis. Alternative care models, including a multidisciplinary approach, need to be evaluated for improvements in clinical outcomes. These data also highlight the importance of addressing NMPP, which may be particularly troublesome for patients.


Assuntos
Dispareunia , Endometriose , Adulto , Estudos Transversais , Dismenorreia/epidemiologia , Dismenorreia/etiologia , Dispareunia/epidemiologia , Dispareunia/etiologia , Endometriose/complicações , Feminino , Humanos , Dor Pélvica/etiologia , Estudos Retrospectivos
20.
Pain ; 162(6): 1681-1691, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33399417

RESUMO

ABSTRACT: Patients with a history of early life stress (ELS) exposure have an increased risk of developing chronic pain and mood disorders later in life. The severity of ELS in patients with urologic chronic pelvic pain syndrome (UCPPS) is directly correlated with symptom severity and increased comorbidity, and is inversely related to likelihood of improvement. Voluntary exercise improves chronic pain symptoms, and our group and others have shown that voluntary wheel running can improve outcomes in stress-induced UCPPS models, suggesting that exercise may negate some of the outcomes associated with ELS. Here, we provide further evidence that voluntary wheel running can attenuate increased perigenital mechanical sensitivity, bladder output, and mast cell degranulation in the bladder and prostate in male mice that underwent neonatal maternal separation (NMS). Sedentary male NMS mice had reduced serum corticosterone, which was not impacted by voluntary wheel running, although stress-related regulatory gene expression in the hypothalamus and hippocampus was significantly increased after exercise. Neurogenesis in the dentate gyrus of the hippocampus was diminished in sedentary NMS mice and significantly increased in both exercised naïve and NMS mice. Sucrose consumption increased in exercised naïve but not NMS mice, and anxiety behaviors measured on an elevated plus maze were increased after exercise. Together these data suggest that voluntary wheel running is sufficient to normalize many of the UCPPS-related outcomes resulting from NMS. Exercise also increased hippocampal neurogenesis and stress-related gene expression within the hypothalamic-pituitary-adrenal axis, further supporting exercise as a nonpharmacological intervention for attenuating outcomes related to ELS exposure.


Assuntos
Experiências Adversas da Infância , Dor Crônica , Condicionamento Físico Animal , Animais , Humanos , Sistema Hipotálamo-Hipofisário , Masculino , Privação Materna , Camundongos , Camundongos Endogâmicos C57BL , Atividade Motora , Dor Pélvica/etiologia , Dor Pélvica/terapia , Sistema Hipófise-Suprarrenal , Estresse Psicológico/terapia
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