General Obstetrics and Gynecology: GynecologyUterine innervation after hysterectomy for chronic pelvic pain with, and without, endometriosis
Section snippets
Patients
Samples from the lower one half of the uterus of 16 consecutive patients with advanced endometriosis (revised American Fertility Society, grades III-IV) who underwent hysterectomy for endometriosis (group 1; mean age, 41.5 years [range, 27-53 years]; nulliparous, 8/16 samples; multiparous, 8/16 samples) were collected. The diagnosis of endometriosis was confirmed by histologic examination in 14 of 16 specimens. Eight uteri had incidental fibroid tumors, and 2 uteri had mild adenomyosis. Samples
Results
Increased numbers of nerve profiles were observed in the myometrium of the lower half of the uterus in endometriosis (group 1 vs group 3; P = .0013, Mann Whitney U test) and chronic pelvic pain (group 2 vs group 3; P = .04) compared with controls (Table; Figure 1, Figure 2, Figure 3, Figure 4). There were no significant differences in the nerve counts between these 2 groups (group 1 vs group 2; P = .35, Mann Whitney U test).
A comparison of uteri from women with chronic pelvic pain with and
Comment
Nerve fiber proliferation in the lower half of the uterus has been observed in women with chronic pelvic pain with and without endometriosis that may contribute to clinical symptoms in both groups. There were no quantitative differences in nerve counts that suggested a similar cause for chronic pelvic pain, irrespective of the presence of ectopic endometrium. Nerve fiber proliferation was extensive, chaotic, and, in some blocks, asymmetric, affecting one half of the uterus to a greater degree.21
Acknowledgment
We thank Peter Clark for the immunohistochemical studies and Andy Vail for the statistical analysis.
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