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Chapter 7 - Evidence for Surgery for Pelvic Pain

Published online by Cambridge University Press:  08 March 2021

By
Nita Desai  and
Anna Reinert
Edited by
Michael Hibner
Michael Hibner
Affiliation:
St Joseph’s Hospital & Medical Center, Phoenix, AZ
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Summary

Among the physicians who see patients for pelvic pain some feel that the only proper treatment is surgery and others that nonsurgical treatment should be the mainstay of therapy. The truth of course lies in the middle, and the most effective providers are not only excellent surgeons but also recognize the importance of physical therapy, pharmacological treatments, and psychological counseling. One of the problems with assessing the effectiveness of surgery and comparing outcomes between the providers is that there are different skill levels, and what one provider calls complete resection of endometriosis or adhesiolysis another may deem as incomplete. In the hands of good and qualified surgeons some procedures unequivocally are beneficial for patients. Resection of endometriosis has clearly been shown to be beneficial provided other causes of pain are also treated. In our practice patients with complete adhesiolysis also seem to have good improvement of pain. It is true that pain may return with time but patients may have few good years, after which they may be candidates for a repeat procedure. Hysterectomy for pain is of course controversial, especially in younger or nulligravid patients.

Type
Chapter
Information
Management of Chronic Pelvic Pain
A Practical Manual
 , pp. 71 - 84
Publisher: Cambridge University Press
Print publication year: 2021

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