Синдром хронической тазовой боли в практике гинеколога

В роботі розкрито механізми виникнення хронічного тазового болю, його патогенетичні засади. Підкреслено тісний зв’язок між синдромом хронічного тазового болю та розвитком ендометріоїдної хвороби, наведено шляхи полегшення тазового болю при вказаній патології. В результаті проведених досліджень доведено високу ефективність дієногесту у подоланні хронічного тазового болю при ендометріозі.In the study the mechanisms of chronic pelvic pain origin and its pathogenetic bases are discussed. Underlined the close connection between chronic pelvic pain syndrome and endometrioid disease development, the ways of pelvic pain relief in this pathology are given. In the results of conducted investigations the high effectiveness of dienogest in chronic pelvic pain syndrome connected with endometriosis is proven

Pelvic Congestion syndrome - common, but underdiagnosed disease of women

Introduction: Pelvic congestion syndrome is defined as the presence of varicose changes in the ovarian veins and venous plexuses associated with chronic pelvic pain syndrome. The main problem with pelvic congestion syndrome is the low awareness of medical staff about this syndrome and the resulting very low recognition.  State of knowledge: Pelvic congestion syndrome is an important cause of chronic pelvic pain. The diagnosis is based on imaging examination with ultrasound as a first-line choice and correlation with clinical presentation. The aetiology is multifactorial and may result from a combination of genetic predisposition, anatomical abnormalities, hormonal, mechanical factors with venous wall weakness, reverse blood flow and hypertension. The incidence is strongly related to the number of pregnancies.  Conclusions: Pelvic congestion syndrome is one of the possible causes of chronic pelvic pain, thus differential diagnosis should necessarily include venous insufficiency during interviewing, clinical and ultrasound examination of patients. Among several treatment methods, intravascular embolization is a minimally invasive, effective and safe, currently recognised as a method of choice in treatment

Ethiopathogenetic Peculiarities of Diagnosis, Clinical Course and Treatment of Chronic Abacterial Prostatitis

Chronic abacterial prostatitis or chronic pelvic pain syndrome remains an urgent problem due to its high prevalence among young men of reproductive age.  Chronic abacterial prostatitis or chronic pelvic pain syndrome, especially its etiology, diagnosis and treatment, is the most discussible issue in the literature and among healthcare professionals. Many modern authors increasingly associate the etiology of this disease with viruses. However, viral etiology of chronic abacterial prostatitis has not been clearly confirmed yet

Evaluation of embolization for periuterine varices involving chronic pelvic pain secondary to pelvic congestion syndrome

OBJECTIVES: To evaluate the clinical response and success rate after periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome and to report the safety of endovascular treatment and its rate of complications. METHODS: Retrospective cohort of patients undergoing endovascular treatment of pelvic congestion syndrome in our department from January 2012 to November 2015. Data were analyzed based on patient background, imaging findings, embolized veins, rate of complications, and clinical response as indicated by the visual analog pain scale. RESULTS: We performed periuterine varices embolization in 22 patients during the study, four of which required a second embolization. Seventeen patients reported a reduction in pelvic pain after the first embolization and three patients reported a reduction in pelvic pain after the second embolization. Minor complications were observed in our patients, such as postural hypotension, postoperative pain, and venous perforation during the procedure, without clinical repercussion. CONCLUSION: Periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome appears to be an effective and safe technique

Chronic pelvic pain

Chronic pelvic pain is defined as pain in the pelvis lasting for more than six months (some say three). The pain may be experienced in any of the structures of the pelvis, including the gynaecological organs; the lower urinary and gastrointestinal tract; and the vascular, neural and musculoskeletal systems. The pain can be continual, cyclical, provoked or unprovoked, and is frequently multifocal. A woman who complains of painful sex, for example, may also report vulvovaginal pain and dyspareunia; bladder frequency, urgency and  suprapubic pain, as well as irritable bowel symptoms. Although an initiating event is sometimes described, such as an episode of severe “thrush” or cystitis, or following pelvic surgery or childbirth, this initial insult may be long forgotten and no longer relevant. Vulvodynia, endometriosis, bladder pain syndrome and irritable bowel syndrome are common causes of chronic pelvic pain in women but are often misdiagnosed and poorly  managed.Keywords: chronic pelvic pain, vulvodynia, vulvar vestibulitis, dyspareunia, painful sex, endometriosi

Altered resting state neuromotor connectivity in men with chronic prostatitis/chronic pelvic pain syndrome: A MAPP: Research Network Neuroimaging Study.

Brain network activity associated with altered motor control in individuals with chronic pain is not well understood. Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a debilitating condition in which previous studies have revealed altered resting pelvic floor muscle activity in men with CP/CPPS compared to healthy controls. We hypothesized that the brain networks controlling pelvic floor muscles would also show altered resting state function in men with CP/CPPS. Here we describe the results of the first test of this hypothesis focusing on the motor cortical regions, termed pelvic-motor, that can directly activate pelvic floor muscles. A group of men with CP/CPPS (N = 28), as well as group of age-matched healthy male controls (N = 27), had resting state functional magnetic resonance imaging scans as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network study. Brain maps of the functional connectivity of pelvic-motor were compared between groups. A significant group difference was observed in the functional connectivity between pelvic-motor and the right posterior insula. The effect size of this group difference was among the largest effect sizes in functional connectivity between all pairs of 165 anatomically-defined subregions of the brain. Interestingly, many of the atlas region pairs with large effect sizes also involved other subregions of the insular cortices. We conclude that functional connectivity between motor cortex and the posterior insula may be among the most important markers of altered brain function in men with CP/CPPS, and may represent changes in the integration of viscerosensory and motor processing

Evaluation Of Acupuncture Therapy For Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Penyakit prostatitis kronikl sindrom sakit pelvis kronik merupakan sejenis sindrom yang mengecewakan, mengelirukan dan kerap ditemui. Chronic prostatitis/ chronic pelvic pain syndrome is a frustrating, confusing and prevalent syndrome

THE PROBLEMS OF NON-SPECIFIC PELVIC PAIN DIAGNOSIS IN WOMEN

Abstract. The article describes the differential diagnosis of chronic pelvic pain in women, discussesterminology and the scheme of non-specific pelvic pain diagnosis. Non-specific pelvic pain (NsPP) is a type of chronic pelvic pain. It occurs in the absence of actual somatic pathology by analogy with the term “non-specific back pain”. The causes of NsPP are the trigger zones of skeletal muscles and ligaments of the pelvis. The authors examined 50 women with NsPP at the age of 20-40 years and revealed myogenic trigger zones in all women: in pelvic floor muscles, in the gluteal muscles, in femoral adductor muscles, in oblique abdominal muscles. Traditionally, these problems are diagnosed as pelvic floor syndrome or coccygodynia with the priority of vertebrogenic etiology of the disease. Althoughthe current literature does not indicate the cause of non-specific pain in the back, it should be recognized that the term includes myogenic (myofascial) pain, as myofascial component plays a key role in NsPP along with central sensitization. In European countries NsPP syndrome is usually treated by urologists, and recommendations for the diagnosis and treatment of chronic pelvic pain include a modern description of pathophysiology and psychosocial aspects, as well as classification, diagnosis and treatment. In Russia it is usually treated by urologists and manual therapists. The diagnosis includes psychometric tests such as Visual Analogue Scale, Menstrual Distress Questionnaire,Pelvic Pain Questionnaire for Girls and Women, Vaginal Laxity Questionnaire, Dismenorrhea Daily Diary etc. The implementation of these tests in the Republic of Tatarstan requires creation of Tatar-language and linguistic validation of Russian-language diagnostic materials.Keywords: pelvic pain, non-specific pelvic pain pain diagnosis,clinical linguistics,neurology, gynecology

Sacral roots stimulation in chronic pelvic pain

Introduction Chronic pelvic pain is a syndrome of chronic non-malignant pain of multifactorial pathophysiology. Perineal, anal and coccygeal pain can be a form of failed-back surgery syndrome or complex regional pain syndrome. Apart from conservative treatment interventional methods are useful in this condition as neurolytic blocks or non-destructive neuromodulation procedures. Peripheral nerve, spinal cord stimulation or sacral stimulation can be applied. Aim We describe a minimally invasive method of sacral roots stimulation with percutaneous electrodes implanted through the sacral hiatus in the treatment of chronic pelvic pain. Materials and methods We evaluated a series of nine female patients with pelvic pain treated with sacral roots stimulation in regard of efficacy and complications of this method. Results Short-term results in all patients were satisfactory with statistically significant improvement (median VAS=9 before surgery) (median VAS=2 after implantation, p=0.001), (median VAS=3 after 6 months, p=0.043). The long-term follow-up revealed less satisfactory result (median VAS=6 after 12 months). High incidence of complications was noted: mainly infection in 3/9 patients. Conclusion Sacral roots stimulation is a non-destructive and minimally invasive neuromodulation method in the treatment of chronic pelvic pain. It can be effective even in the long-term observation but special care is advised to secure aseptic conditions in the implantation and to prevent the infection which leads to removal of the stimulating system

An Uncommon Manifestation of Fitz-Hugh-Curtis Syndrome with Right-side Chest Pain

Fitz-Hugh-Curtis syndrome is characterized by an inflammation of the perihepatic capsules associated with pelvic inflammatory disease. The typical symptom is severe right upper quadrant abdominal pain. We report a patient with Fitz-Hugh-Curtis syndrome who presented with an atypical chief complaint of right-side chest pain unaccompanied by symptoms specific to pelvic inflammatory disease. This case indicates that Fitz-Hugh-Curtis syndrome should be considered in the differential diagnosis of right-side chest pain in young women, because early diagnosis and treatment of the disease are essential to prevent chronic complications