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Outcomes following surgical management of pelvic pain : a prospective cohort study

University of British Columbia

Endometriosis is a chronic, estrogen-mediated inflammatory condition associated with chronic pelvic pain and infertility. The condition affects up to 10% of reproductive aged women and is associated with significant impacts on quality of life, loss of productivity, and social isolation. Surgical intervention has been identified as an important tool in treatment of endometriosis, but the factors associated with treatment response are not clearly defined. Our current study aimed to address these issues by determining the impact of type of surgery, histology, and stage of endometriosis on surgical outcomes. We then evaluated whether conservative surgery for superficial peritoneal endometriosis resulted in positive impacts on pain and quality of life. Finally, we determined whether the characteristics of women undergoing hysterectomies before the age of 40 were different from those of women undergoing hysterectomies at age 40 or older and compared their surgical outcomes by age category. The first part of the thesis demonstrated that surgery was associated with improvement in all surgical outcomes regardless of type of surgery. Women undergoing hysterectomies demonstrated worse baseline quality of life scores but showed greater improvement in outcomes compared to conservative surgery. Stage and histology had little influence on outcomes. For the second part of our study, we found that surgery for superficial peritoneal endometriosis was associated with improvement in all outcomes except for superficial dyspareunia. Finally, the third part of study demonstrated that younger women undergoing hysterectomies tended to have earlier experiences of pain and increased likelihood of having comorbid conditions associated with central sensitization. Women <40 years of age demonstrated greater improvement in deep dyspareunia, while women above 40 had more improvement in depression. Overall, our study demonstrates that surgical intervention is associated with improvements in both pain and psychological scores. Future studies will expand on our findings through longer- follow-up and by linking our data to provincial administrative databases in order to look at outcomes such as reoperation rates. Our ultimate goal is to determine the predictors of successful surgical outcomes to create a predictive model for endometriosis-related pelvic pain.

Text

2024-05-31

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/76321

Reproductive and Developmental Sciences

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/