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- Title
Six-month follow-up of minimally invasive nerve-sparing complete excision of endometriosis: What about dyspareunia?
- Authors
Crispi, Claudio Peixoto; de Oliveira, Bruna Rafaela Santos; de Nadai Filho, Nilton; Peixoto-Filho, Fernando Maia; Fonseca, Marlon de Freitas
- Abstract
Study objective: To assess individual changes of deep dyspareunia (DDyspareunia) six months after laparoscopic nerve-sparing complete excision of endometriosis, with or without robotic assistance. Methods: This preplanned interdisciplinary observational study with a retrospective analysis of intervention enrolled 126 consecutive women who underwent surgery between January 2018 and September 2019 at a private specialized center. Demographics, medical history and surgery details were recorded systematically. DDyspareunia (primary outcome), dysmenorrhea and acyclic pelvic pain were assessed on self-reported 11-point numeric rating scales both preoperatively and at six-month follow-up. Cases with poor prognosis in relation to dyspareunia were described individually in greater detail. Results: Preoperative DDyspareunia showed weak correlation with dysmenorrhea (rho =.240; P =.014) and pelvic pain (rho =.260; P =.004). Although DDyspareunia improved significantly (P <.001) by 3 points or more in 75.8% (95%CI: 64.7–86.2) and disappeared totally in 59.7% of cases (95%CI:47.8–71.6), individual analysis identified different patterns of response. The probability of a preoperative moderate/severe DDyspareunia worsening more than 2 points was 4.8% (95%CI: 0.0–10.7) and the probability of a woman with no DDyspareunia developing "de novo" moderate or severe DDyspareunia was 7.7% (95%CI: 1.8–15.8) and 5.8% (95%CI: 0.0–13.0), respectively. In a qualitative analysis, several conditions were hypothesized to impact the post-operative DDyspareunia response; these included adenomyosis, mental health disorders, lack of hormone therapy after surgery, colporrhaphy, nodule excision in ENZIAN B compartment (uterosacral ligament/parametrium), the rectovaginal septum or the retrocervical region. Conclusion: Endometriosis surgery provides significant improvement in DDyspareunia. However, patients should be alerted about the possibility of unsatisfactory results.
- Subjects
DYSPAREUNIA; PELVIC pain; ENDOMETRIOSIS; MENTAL illness; MENTAL health; HORMONE therapy; SURGICAL robots
- Publication
PLoS ONE, 2021, Vol 16, Issue 4, p1
- ISSN
1932-6203
- Publication type
Article
- DOI
10.1371/journal.pone.0250046