Introduction and hypothesis
Endometriosis involving the sacral plexus is still poorly understood or neglected by many surgeons. Looking at that scenario, we have designed this educational video to explain and describe the symptoms suggestive of endometriotic involvement of the sacral plexus in addition to the technique for the laparoscopic treatment of this condition.
Retrospective analysis of 13 consecutive cases of endometriotic entrapment of nerves of the lumbosacral plexus.
Paired t test revealed a statistically significant (p < 0.0000001) reduction in pain VAS score, from preoperative average 9.1 (±1.98) to postoperative 1.46 (±1.66). Twelve out of 13 patients (92.3 %) experienced a reduction of 50 % or more in VAS score and 6 (46.15 %) became completely pain-free.
The signs suggestive of intrapelvic nerve involvement include perineal pain or pain irradiating to the lower limbs, lower urinary tract symptoms, tenesmus or dyschezia associated with gluteal pain. Whenever deeply infiltrating lesions are present, the patient must be asked about those symptoms and specific MRI sequences for the sacral plexus must be taken, so that the equipment and team can be arranged and proper treatment performed.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
DENTON RO, SHERRILL JD. Sciatic syndrome due to endometriosis of sciatic nerve. South Med J. 1955 Oct;48(10):1027-31.
Possover M, Schneider T, Henle KP (2011) Laparoscopic therapy for endometriosis and vascular entrapment of sacral plexus. Fertil Steril 95(2):756–758
Russel SM (2006) Examination of peripheral nerve injuries. Thieme, New York
Possover M, Lemos N (2011) Risks, symptoms, and management of pelvic nerve damage secondary to surgery for pelvic organ prolapse: a report of 95 cases. Int Urogynecol J 22(12):1485–1490
Lemos N, Kamergorodsky G, Ploger C, Castro R, Schor E, Girão M (2012) Sacral nerve infiltrative endometriosis presenting as perimenstrual right-sided sciatica and bladder atonia: case report and description of surgical technique. J Minim Invasive Gynecol 19(3):396–400
Written informed consent was obtained from the patient for publication of this video article and any accompanying images.
Conflict of interest
Nucelio Lemos receives research grants from Medtronic Inc. and Laborie Inc. and proctorship grants from Medtronic Inc. None of these grants is, however, directly related to the current publication.
Eduardo Schor receives research grants from Abbott Inc. and Libbs Inc. and speaker/proctor grants from AstraZeneca Inc. None of these grants is directly related to the current publication.
None of the other co-authors has anything to disclose.
N. Lemos: project development, data collection, manuscript writing; N. D’Amico: project development, data collection; R.M. Marques: project development, data collection; G. Kamergorodsky: data collection; E. Schor: project development, data collection; M.J.B.C. Girão: project development, manuscript writing.
Electronic supplementary material
Below is the link to the electronic supplementary material.
(MP4 86541 kb)
About this article
Cite this article
Lemos, N., D’Amico, N., Marques, R. et al. Recognition and treatment of endometriosis involving the sacral nerve roots. Int Urogynecol J 27, 147–150 (2016) doi:10.1007/s00192-015-2703-z
- Deeply infiltrating endometriosis
- Lumbosacral plexus
- Urinary symptoms
- Pudendal pain