Bladder dysfunction after repeat laparoscopic uterine nerve ablation (LUNA)

Fitzpatrick, Christopher C.; Flood, Hugh D.; Punch, Margaret R.; Hilgers, Thomas; Elkins, Thomas E.; McGuire, Edward J.

doi:10.1007/bf01961846

Cited by 8 publications

(3 citation statements)

References 15 publications

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“…It was concluded that there was insufficient evidence to recommend the routine use of LUNA in the management of chronic pelvic pain, but suggested there may be a difference in response between women with endometriosis and those with chronic pelvic pain in the absence of endometriosis. There have been isolated case reports of uterine prolapse 13,14 and bladder dysfunction 15 following LUNA, although the complication rate attributable directly to LUNA appears to be extremely low 12 . Other adverse effects of neuroablation, such as haematoma formation, constipation and subsequent painless labour, appear to be more associated with presacral neurectomy (PSN) than LUNA.…”

Section: Introductionmentioning

confidence: 99%

A double‐blind randomised controlled trial of laparoscopic uterine nerve ablation for women with chronic pelvic pain

Johnson

Farquhar

Crossley

et al. 2004

BJOG

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Objective To determine the effectiveness of laparoscopic uterine nerve ablation (LUNA) for chronic pelvic pain in women with endometriosis and women with no laparoscopic evidence of endometriosis. Design A prospective double-blind randomised controlled trial (RCT).Setting Single-centre, secondary-level gynaecology outpatient service and tertiary-level pelvic pain and endometriosis outpatient service in Auckland, New Zealand. Population One hundred and twenty-three women undergoing laparoscopy for investigation and management of chronic pelvic pain, 56 with no laparoscopic evidence of endometriosis and 67 with endometriosis. Methods Women were randomised from the two populations, firstly those with no evidence of endometriosis and secondly those undergoing laparoscopic surgical treatment for endometriosis, to receive LUNA or no LUNA. Participant and assessor blinding was employed. Follow up for pain outcomes was undertaken at 24 hours, 3 months and 12 months. Main outcome measures Changes in non-menstrual pelvic pain, dysmenorrhoea, deep dyspareunia and dyschezia were assessed primarily by whether there was a decrease in visual analogue score for these types of pain of 50% or more from baseline and additionally whether there was a significantly different change in median visual analogue score. The numbers requiring further surgery or starting a new medical treatment for pelvic pain and complications were also measured. Results There was a significant reduction in dysmenorrhoea at 12 month follow up in women with chronic pelvic pain in the absence of endometriosis who underwent LUNA (median change in visual analogue scale (VAS) from baseline À4.8 versus À0.8 (P ¼ 0.039), 42.1% versus 14.3% experiencing a successful treatment defined as a 50% or greater reduction in visual analogue pain scale for dysmenorrhoea (P ¼ 0.045).There was no significant difference in non-menstrual pelvic pain, deep dyspareunia or dyschezia in women with no endometriosis undergoing LUNA versus no LUNA. The addition of LUNA to laparoscopic surgical treatment of endometriosis was not associated with a significant difference in any pain outcomes. Conclusions LUNA is effective for dysmenorrhoea in the absence of endometriosis, although there is no evidence of effectiveness of LUNA for non-dysmenorrhoeic chronic pelvic pain or for any type of chronic pelvic pain related to endometriosis.

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Section: Introductionmentioning

confidence: 99%

A double‐blind randomised controlled trial of laparoscopic uterine nerve ablation for women with chronic pelvic pain

Johnson

Farquhar

Crossley

et al. 2004

BJOG

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“…A long‐term study showed that success rates declined rapidly over time from 72% in the first year to 39% in the fourth for LUNA. 23 Others have suggested a possible risk of anatomical distortion such as uterine prolapse 24,25 and bladder dysfunction 26 following LUNA. There is also the concern regarding the effects of interruption of the pelvic nerves to the uterine muscles in subsequent pregnancies, such as painless labour.…”

Section: Introductionmentioning

confidence: 99%

Surgical pelvic neuroablation for chronic pelvic pain: a systematic review

Johnson¹,

Wilson²,

Farquhar³

2000

Gynaecol Endoscopy

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Objective To determine, from the best available evidence, the effectiveness of surgical pelvic neuroablative techniques as treatment for primary and secondary dysmenorrhoea. Design Systematic review of randomized controlled trials (RCTs). Subjects Women with primary or secondary dysmenorrhoea. Interventions Surgical neuroablative techniques including uterine nerve ablation and presacral neurectomy. Main outcome measures Pain relief (both short‐ and long‐term) and adverse effects. Results Laparoscopic uterine nerve ablation (LUNA) has been shown by one small study to be effective for primary dysmenorrhoea up to 12 months. A larger study showed no significant difference between LUNA and laparoscopic presacral neurectomy (LPSN) in pain relief for primary dysmenorrhoea up to 6 months, but LPSN was significantly more effective beyond 6 months. For dysmenorrhoea secondary to endometriosis, two trials found no significant difference in pain relief afforded by LUNA plus conservative laparoscopic surgery for endometriosis vs. conservative laparoscopic surgery alone. Presacral neurectomy (PSN) plus conservative surgery for endometriosis at laparotomy vs. conservative surgery for endometriosis at laparotomy showed no significant difference in overall pain relief, although there was a significant difference in relief of midline abdominal pain. Adverse events overall were significantly more common following PSN; these included constipation, urinary urgency, painless labour and one case necessitating a laparotomy for presacral haematoma 2 days after PSN. Conclusions There is insufficient evidence to recommend the use of surgical pelvic neuroablation in the management of dysmenorrhoea, regardless of cause. Further scientifically rigorous RCTs should be undertaken.

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“…In addition both operations only partially interrupt some of the cervical sensory nerve fibers in the pelvic area; therefore dysmenorrhea associated with additional pelvic pathology may not always benefit from this type of surgery. Other concerns are the risk of anatomical distortion such as uterine prolapse and bladder dysfunction (40, 41). There is also concern regarding the effects of interruption of the pelvic nerves to the uterine muscles in subsequent pregnancies, including an effect like painless labor.…”

Section: Resultsmentioning

confidence: 99%