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Obstetrics and Gynecology Oct 2023We use the person-centered Pathway to Treatment framework to assess the scope of evidence on disparities in endometrial cancer stage at diagnosis. This report is... (Review)
Review
OBJECTIVE
We use the person-centered Pathway to Treatment framework to assess the scope of evidence on disparities in endometrial cancer stage at diagnosis. This report is intended to facilitate interventions, research, and advocacy that reduce disparities.
DATA SOURCES
We completed a structured search of electronic databases: PubMed, EMBASE, Scopus, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials databases. Included studies were published between January 2000 and 2023 and addressed marginalized population(s) in the United States with the ability to develop endometrial cancer and addressed variable(s) outlined in the Pathway to Treatment.
METHODS OF STUDY SELECTION
Our database search strategy was designed for sensitivity to identify studies on disparate prolongation of the Pathway to Treatment for endometrial cancer, tallying 2,171. Inclusion criteria were broad, yet only 24 studies addressed this issue. All articles were independently screened by two reviewers.
TABULATION, INTEGRATION, AND RESULTS
Twenty-four studies were included: 10 on symptom appraisal, five on help seeking, five on diagnosis, and 10 on pretreatment intervals. Quality rankings were heterogeneous, between 3 and 9 (median 7.2) per the Newcastle-Ottawa Scale. We identified three qualitative, two participatory, and two intervention studies. Studies on help seeking predominantly investigate patient-driven delays. When disease factors were controlled for, delays of the pretreatment interval were independently associated with racism toward Black and Hispanic people, less education, lower socioeconomic status, and nonprivate insurance.
CONCLUSIONS
Evidence gaps on disparities in timeliness of endometrial cancer care reveal emphasis of patient-driven help-seeking delays, reliance on health care-derived databases, underutilization of participatory methods, and a paucity of intervention studies.
SYSTEMATIC REVIEW REGISTRATION
Given that PROSPERO was not accepting systematic scoping review protocols at the time this study began, this study protocol was shared a priori through Open Science Framework on January 13, 2021 (doi: 10.17605/OSF.IO/V2ZXY), and through peer review publication on April 13, 2021 (doi: https://doi.org/10.1186/s13643-021-01649-x).
Topics: Female; Humans; Black People; Databases, Factual; Educational Status; Endometrial Neoplasms; Health Facilities; Healthcare Disparities; Time Factors; Time-to-Treatment; Hispanic or Latino; Social Determinants of Health
PubMed: 37734095
DOI: 10.1097/AOG.0000000000005338 -
Medicine Oct 2020This systematic review and meta-analysis aim to assess the effectiveness of Dangguijagyag-san (DJS) for primary dysmenorrhea (PD) and to update the previous reviews. (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systematic review and meta-analysis aim to assess the effectiveness of Dangguijagyag-san (DJS) for primary dysmenorrhea (PD) and to update the previous reviews.
METHODS
We searched for randomized controlled trials (RCTs) of DJS for PD from inception to April 2019. The search databases were the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Oriental Medicine Advanced Searching Integrated System, Korean Traditional Knowledge Portal, Korean Medical Database, National Digital Science Library, and the China National Knowledge Infrastructure. The selection of studies, the extraction of data, and the quality assessment with risk of bias tool were performed by 2 authors independently. To analyze the data, the meta-analysis was conducted and qualitative analysis was also performed.
RESULTS
Total 2766 studies were identified, and 14 RCTs were enrolled in this review. According to the type of interventions, the analysis was performed in 4 groups. In comparison to western medication, DJS showed a higher total effective rate (TER) (RR 1.16, 95% CI 1.08-1.24) and a higher effect in reducing the pain (MD = -0.86, 95% CI -1.56--0.16). Compared with placebo, DJS was superior to placebo in reducing pain (MD = -1.1, 95% CI -2.04 --0.16) and also in reducing the consumption of the rescue medication during menstrual period (MD = -2.3, 95% CI -3.58--1.02). Compared with other herbal medicines, the subgroup analysis showed that DJS applied with PD of differentiated patterns had a higher total effective rate (TER) (RR 1.21, 95% CI 1.03-1.43, P=.02). DJS with moxibustion as an adjuvant therapy was also more effective than western medication (RR 1.47, 95% CI 1.23-1.76).
CONCLUSION
DJS may be effective for the treatment of PD. However, the quality of the evidence is relatively low, so larger-scale and well-designed RCTs are needed to confirm the effects of DJS.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration number is CRD42019130768.
Topics: Combined Modality Therapy; Drugs, Chinese Herbal; Dysmenorrhea; Female; Humans; Moxibustion; Randomized Controlled Trials as Topic
PubMed: 33080743
DOI: 10.1097/MD.0000000000022761 -
Medicine Jul 2021Primary dysmenorrhea (PD), one of the most common diseases in women, is known to be effective with object-separated moxibustion. However, because there is no large... (Comparative Study)
Comparative Study Meta-Analysis
Comparative efficacy and dysmenorrhea score of 6 object-separated moxibustions for the treatment of Chinese patients with dysmenorrhea: A systematic review and network meta-analysis.
BACKGROUND
Primary dysmenorrhea (PD), one of the most common diseases in women, is known to be effective with object-separated moxibustion. However, because there is no large sample size for comparison, it is difficult to choose the best method for the clinical treatment of these different treatments. Therefore, our aim was to compare and rank different moxibustion methods to determine the most effective treatment method for PD.
MATERIALS AND METHODS
A systematic search was carried out in PubMed, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, and Chinese Biomedical Literature, to identify the randomized controlled trials (RCTs) investigated the object-separated moxibustion is associated with dysmenorrhea, as well as we also manually checked the bibliographies of eligible studies and topic-related reviews, RCTs from their inception to May 1, 2020. Three investigators read the citations and excluded quasi-randomized trials and trials that were incomplete. We extracted data following a predefined hierarchy. We assessed the studies' risk of bias in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The primary outcomes were efficacy (response rate) and dysmenorrhea scores. We estimated the summary odds ratio (OR) and mean difference (MD) using pairwise and network meta-analyses with random effects. STATA software version 16.0, ADDIS software version 1.16.5, and R software version 3.6.1 were used to statistically analyze all data.
RESULTS
Fifty-six RCTs with 5550 patients were included, comparing 6 object-separated moxibustion therapies with acupuncture or oral medicine. All moxibustions were more effective than ibuprofen, with OR ranging between 6.75 (95%CI: 3.58 to 13.22) for moxibustion at the navel. For relieving pain which uses dysmenorrhea score to evaluate, mild moxibustion (MD = -1.42, -4.24 to 0.85) was more effective than others. A total of 24 (42.8%) of 56 trials were rated as having a high risk of bias, 31(55.4%) as moderate, and 1(1.8%) as low, and the certainty of the evidence was moderate.
CONCLUSIONS
Mild moxibustion cannot only effectively treat PD but also relieve pain in comparison with ibuprofen. Although GRADE evidence indicate low to moderate for most comparisons, mild moxibustion seems to be an advisable option for PD treatment to relieve symptoms.
Topics: Analgesics, Non-Narcotic; Bayes Theorem; China; Dysmenorrhea; Female; Humans; Ibuprofen; Moxibustion; Network Meta-Analysis; Pain; Randomized Controlled Trials as Topic
PubMed: 34190145
DOI: 10.1097/MD.0000000000026185 -
Computational Intelligence and... 2022To compare the efficacy of uterine artery embolization (UAE) with traditional methods for treating endometriosis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the efficacy of uterine artery embolization (UAE) with traditional methods for treating endometriosis.
METHODS
The randomized controlled trials of uterine artery embolization and other medical treatments for endometriosis in PubMed, Embase, Web of Science, Cochrane Library, China Journal Full-Text Database, Wanfang Database, VIP Database, and China Biomedical Literature Database were retrieved by computer. The search time was up to June 2022. The quality of articles was evaluated by Cochrane ROB 2.0, and meta-analysis was performed by Stata15.1 software.
RESULTS
7 studies were finally included. Meta-analysis showed that the serum CA125 level after uterine artery embolization was significantly lower than that in the control group (SMD = -0.85, 95%CI (-1.12, -0.59)], and the postoperative visual analogue scale (VAS) of dysmenorrhea was significantly lower than that in the control group (SMD = -1.86, 95%CI (-2.21, -1.50)) There was no significant difference in the effective rate, FSH level, E2 level, and LH level between the two groups.
CONCLUSION
UAE can effectively reduce the VAS score of dysmenorrhea and serum CA125 level for treating endometriosis. However, due to the limitation of the quality of included articles, more large sample size and high quality RCTs are needed to provide stronger evidence-based medicine evidence for clinical practice.
Topics: China; Dysmenorrhea; Endometriosis; Female; Follicle Stimulating Hormone; Humans; Uterine Artery Embolization
PubMed: 36248948
DOI: 10.1155/2022/8966063 -
Acta Obstetricia Et Gynecologica... Aug 2020Epidemiological studies have shown that some hormonal contraceptive methods are associated with increased breast cancer risk, especially if used over long periods. Our... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Epidemiological studies have shown that some hormonal contraceptive methods are associated with increased breast cancer risk, especially if used over long periods. Our objective was to conduct a systematic review and meta-analysis of the literature on the risk of breast cancer development in women using the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS).
MATERIAL AND METHODS
We performed a thorough review of peer-reviewed publications from 10 January 1999, through 31 July 2019, using combinations of search terms for breast cancer risk and LNG-IUS in the Medline, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), and Scielo databases. This review was registered in PROSPERO (CRD42017059076). Studies reporting breast cancer risk estimates among healthy users of LNG-IUS were included according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) criteria. Two authors performed data extraction, and a third author resolved disagreements. The quality of evidence was evaluated using the Downs and Black instrument. A funnel plot was generated, and a linear regression test of funnel plot asymmetry was used to assess publication bias. Finally, we performed a random-effects model (owing to high study heterogeneity) meta-analysis of seven suitable studies, stratified by the age distribution of patients (<50 years, ≥50 years, and mixed).
RESULTS
We identified 96 studies and manually cross-referenced and excluded duplicate articles. Seventy articles were excluded on the basis of the inclusion and exclusion criteria, resulting in the assessment of 26 full-text articles. Eight articles were considered adequate for inclusion in this systematic review, and seven studies were included in the meta-analysis. Three publications were case-control studies and five were cohort studies. According to the Downs and Black instrument, 5 studies were rated as "good" and 3 studies were deemed "fair". Our meta-analysis results indicated increased breast cancer risk in LNG-IUS users: for all women, odds ratio (OR) = 1.16 (95% CI 1.06-1.28, I = 78%, P < .01); for women aged <50 years, OR = 1.12 (95% CI 1.02-1.22, I = 66%, P = .02); and for women aged ≥50 years, OR = 1.52 (95% CI 1.34-1.72, I = 0%, P = .84).
CONCLUSIONS
Current evidence suggests that LNG-IUS users have an increased breast cancer risk regardless of age and indication. The effect of LNG-IUS on breast cancer risk seems to be larger in older users. However, our systematic review detected methodological issues across the available studies, and confounding factors may be responsible for at least a fraction of the risk effects associated with LNG-IUS use. Nevertheless, users of LNG-IUS should be aware of these trends. We believe that caution is needed, and risks should be balanced against proven health benefits (eg effective treatment of heavy menstrual bleeding and avoidance of surgical interventions), when prescribing LNG-IUS for long periods of use, especially in women with other known breast cancer risk factors such as old age, obesity, and familial predisposition.
Topics: Breast Neoplasms; Contraceptive Agents, Female; Female; Humans; Intrauterine Devices, Medicated; Levonorgestrel; Risk Factors
PubMed: 31990981
DOI: 10.1111/aogs.13817 -
European Journal of Obstetrics,... Feb 2024For patients with endometrioma it is unclear what treatment: surgery and/or medication, is more effective in reducing pain and improving quality of life (QoL). This... (Meta-Analysis)
Meta-Analysis Review
For patients with endometrioma it is unclear what treatment: surgery and/or medication, is more effective in reducing pain and improving quality of life (QoL). This systematic review and meta- analysis aimed to provide an overview of the existing evidence on the effects of surgery and/or medication (i.e. analgesics and/or hormonal medication) on pain and QoL. A search through CENTRAL, MEDLINE and Embase was conducted. The study population had to be women treated for endometrioma. Retrospective or prospective studies reporting about QoL and/or the following types of pain were reviewed: dysmenorrhea, dyspareunia, chronic pelvic pain, and pain that was not well defined in the included article (referred to as pain). We performed a meta-analysis on mean visual analogue scale (VAS) scores and proportions of patients experiencing different types of pain over time. QoL was described narratively. Out of 11.515 articles, 76 studies including 7148 patients were included for the systematic review. The meta-analysis consisted of 52 studies including 4556 patients. No studies compared medication with surgery. And there were no studies on analgesics. Meta-analysis showed that surgery and/or medication often reduced VAS scores and proportions of all types of pain over time. Surgery and medication combined seems more effective in reducing VAS scores of pain compared to surgery alone, but not to medication alone (estimated mean difference = 0.17, p < 0.0001 and -0.98, p = 0.0339). QoL improved after medication (follow up ≤ 12 months) and QoL was unchanged or worsened after surgery and medication combined (follow up ≤ 24 months). However, these were results from a total of 5 studies. Both surgery and medication reduce endometriosis-related pain in patients with endometrioma. However, there is lack of uniform, good quality data comparing surgery with medication to draw firm conclusions. For better-informed treatment decisions, further studies including a standardized core-outcome set at fixed follow-up times, are necessary.
Topics: Humans; Female; Endometriosis; Quality of Life; Prospective Studies; Retrospective Studies; Pelvic Pain; Analgesics
PubMed: 38134610
DOI: 10.1016/j.ejogrb.2023.12.012 -
Clinical Nursing Research Sep 2022Acupuncture and moxibustion have been accepted as add-on options for primary dysmenorrhea (PD); however, the clinical evidence is still inadequate. We searched AMED,... (Meta-Analysis)
Meta-Analysis
Acupuncture and moxibustion have been accepted as add-on options for primary dysmenorrhea (PD); however, the clinical evidence is still inadequate. We searched AMED, CENTRAL, EMBASE, PubMed, Web of Science, CBM, CNKI, VIP, Wangfang database, ANZCTR, ClinicalTrials.gov, and the WHO ICTRP, from their inception to February 2021. The pooled analysis of 13 RCTs with 675 participants for VAS showed that acupuncture and moxibustion were more effective in managing PD than the control group with the MD of -1.93 (95% CI [-2.80, -1.06] and -2.67 (95% CI [-4.96, -0.38]). With the CMSS, seven studies with 487 participants showed that these modalities were more effective than the control group with the MD of -7.58 (95% CI [-10.97, -4.19]) and -3.78 (95% CI [-6.90, -0.66]). The findings indicated that acupuncture and moxibustion could relieve pain effectively and has fewer adverse events (AEs) in managing PD.
Topics: Acupuncture Therapy; Dysmenorrhea; Female; Humans; Moxibustion
PubMed: 35499150
DOI: 10.1177/10547738221086984 -
Frontiers in Medicine 2022The stressful academic schedule of medical students poses an obvious challenge to their daily lifestyle. Psychosomatic discomfort poses a significant risk for inaccurate...
BACKGROUND
The stressful academic schedule of medical students poses an obvious challenge to their daily lifestyle. Psychosomatic discomfort poses a significant risk for inaccurate self-medication for ameliorating menstrual complications and feeling better, thus directly impacting personal and academic wellbeing.
OBJECTIVE
The impact of menstrual disturbances on academic life is not extensively explored. Therefore, the primary objective of this research was to probe the prevalence of menstrual disturbances and assess the academic and social impact. Finally, the authors provide an overview of pharmacological and other interventions students adopt to reduce clinical symptoms.
METHODS
A database search was conducted from the year 2016 till September 2021 for the studies reporting the prevalence of menstrual disorders in all geographic locations of the world. Keywords used for searching databases included "menstrual disturbances" and "medical students," "prevalence" OR "symptoms" of "Premenstrual syndrome" OR "Premenstrual dysphoric disorder" OR "Dysmenorrhea" in medical students. Prospero Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) protocols were followed. The protocol was registered in the International prospective register of systematic reviews (PROSPERO), the Center for Reviews and Dissemination, University of York (CRD42021277962). The quality of the methodologies used in selected studies was evaluated by a modified version of Newcastle Ottawa Scale (NOS).
RESULTS
Initially, 1527 articles were available. After a review, 26 papers were selected for analysis. A total of 25 citations were identified for quantitative analyses, out of which 16 studies reported Pre-menstrual syndrome, 7 reported Pre-menstrual dysphoric disorder, and 13 articles reported dysmenorrhea. The pooled prevalence of Pre-menstrual syndrome was 51.30%, Pre-menstrual dysphoric disorder was 17.7%, and dysmenorrhea was 72.70%. Most common associated lifestyle factors were stress, excessive caffeine intake and lack of exercise. Painkillers, hot packs and hot beverages were amongst the common measures taken by the students to relieve their symptoms.
CONCLUSIONS
The current situation calls for action to accommodate students' needs and bridge the social gap regarding menstrual health. Proactive measures by medical educators and stakeholders are required for an inclusive, accommodating educational environment which will minimize the gender discrepancy in academic satisfaction and professional life.
PubMed: 35242785
DOI: 10.3389/fmed.2022.821908 -
Human Reproduction Open 2021Which outcomes and outcome measures are reported in interventional trials evaluating the treatment of adenomyosis? (Review)
Review
STUDY QUESTION
Which outcomes and outcome measures are reported in interventional trials evaluating the treatment of adenomyosis?
SUMMARY ANSWER
We identified 38 studies, reporting on 203 outcomes using 133 outcome measures.
WHAT IS KNOWN ALREADY
Heterogeneity in outcome evaluation and reporting has been demonstrated for several gynaecological conditions and in fertility studies. In adenomyosis, previous systematic reviews have failed to perform a quantitative analysis for central outcomes, due to variations in outcome reporting and measuring.
STUDY DESIGN SIZE DURATION
A systematic search of Embase, Medline and Cochrane Register of Controlled Trials (CENTRAL) was performed with a timeframe from 1950 until February 2021, following the preferred reporting items for systematic reviews and meta-analysis (PRISMA).
PARTICIPANTS/MATERIALS SETTING METHODS
Studies reporting on any uterus-sparing intervention to treat adenomyosis, both prospective and retrospective, were eligible for inclusion. Inclusion criteria were a clear definition of diagnostic criteria for adenomyosis and the modality used to make the diagnosis, a clear description of the intervention, a follow-up time of ≥6 months, a study population of n ≥ 20, a follow-up rate of at least 80%, and English language. The population included premenopausal women with adenomyosis. Risk of bias was assessed using the Evidence Project risk of bias tool.
MAIN RESULTS AND THE ROLE OF CHANCE
We included 38 studies (6 randomized controlled trials and 32 cohort studies), including 5175 participants with adenomyosis. The studies described 10 interventions and reported on 203 outcomes, including 43 classified as harms, in 29 predefined domains. Dysmenorrhoea (reported in 82%), heavy menstrual bleeding (HMB) (in 79%) and uterine volume (in 71%) were the most common outcomes. Fourteen different outcome measures were used for dysmenorrhoea and 17 for HMB. Quality of life was reported in 9 (24%) studies, patient satisfaction with treatment in 1 (3%). A clear primary outcome was stated in only 18%.
LIMITATIONS REASONS FOR CAUTION
This review includes studies with a high risk of bias.
WIDER IMPLICATIONS OF THE FINDINGS
Shortcomings in the definition and choice of outcomes and outcome measures limit the value of the conducted research. The development and implementation of a core outcome set (COS) for interventional studies in adenomyosis could improve research quality. This review suggests a lack of patient-centred research in adenomyosis and people with adenomyosis should be involved in the development and implementation of the COS.
STUDY FUNDING/COMPETING INTERESTS
No funds specifically for this work were received. T.T. receives fees from General Electrics for lectures on ultrasound independently of this project.
TRIAL REGISTRATION NUMBER
This review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42020177466) and the Core Outcome Measures in Effectiveness Trials (COMET) initiative (registration number 1649).
PubMed: 34466664
DOI: 10.1093/hropen/hoab030 -
The Cochrane Database of Systematic... Dec 2021Chronic pelvic pain (CPP) is a common gynaecological condition accounting for 20% of all gynaecological referrals. There are wide ranges of causes with overlapping... (Review)
Review
BACKGROUND
Chronic pelvic pain (CPP) is a common gynaecological condition accounting for 20% of all gynaecological referrals. There are wide ranges of causes with overlapping symptomatology, therefore the management of the condition is a formidable challenge for clinicians. The aetiology of CPP is heterogeneous and in many cases, no clear diagnosis can be reached. It is in this scenario that the label of chronic pelvic pain syndrome (CPPS) can be applied. We defined women with CPPS as having a minimum duration of pain of at least 6 months, including with a diagnosis of pelvic congestion syndrome, but excluding pain caused by a condition such as endometriosis. Many surgical interventions have been tried in isolation or in conjunction with non-surgical interventions in the management with variable results. Surgical interventions are invasive and carry operative risks. Surgical interventions must be evaluated for their effectiveness prior to their prevalent use in the management of women with CPPS.
OBJECTIVES
To review the effectiveness and safety of surgical interventions in the management of women with CPPS.
SEARCH METHODS
We searched the Cochrane Gynaecology and Fertility Group (CGF) Specialised Register of Controlled Trials, CENTRAL, MEDLINE, Embase and PsycINFO, on 23 April 2021 for any randomised controlled trials (RCT) for surgical interventions in women with CPPS. We also searched the citation lists of relevant publications, two trial registries, relevant journals, abstracts, conference proceedings and several key grey literature sources.
SELECTION CRITERIA
RCTs with women who had CPPS. The review authors were prepared to consider studies of any surgical intervention used for the management of CPPS. Outcome measures were pain rating scales, adverse events, psychological outcomes, quality of life (QoL) measures and requirement for analgesia.
DATA COLLECTION AND ANALYSIS
Two review authors independently evaluated studies for inclusion and extracted data using the forms designed according to Cochrane guidelines. For each included trial, we collected information regarding the method of randomisation, allocation concealment, blinding, data reporting and analyses. We reported pooled results as mean difference (MDs) or odds ratios (OR) and 95% confidence interval (CI) by the Mantel-Haenszel method. If similar outcomes were reported on different scales, we calculated the standardised mean difference (SMD). We applied GRADE criteria to judge the overall certainty of the evidence.
MAIN RESULTS
Four studies met our inclusion criteria involving 216 women with CPP and no identifiable cause. Adhesiolysis compared to no surgery or diagnostic laparoscopy We are uncertain of the effect of adhesiolysis on pelvic pain scores postoperatively at three months (MD -7.3, 95% CI -29.9 to 15.3; 1 study, 43 participants; low-certainty evidence), six months (MD -14.3, 95% CI -35.9 to 7.3; 1 study, 43 participants; low-certainty evidence) and 12 months postsurgery (MD 0.00, 95% CI -4.60; 1 study, 43 participants; very low-certainty evidence). Adhesiolysis may improve both the emotional wellbeing (MD 24.90, 95% CI 7.92 to 41.88; 1 study, 43 participants; low-certainty evidence) and social support (MD 23.90, 95% CI -1.77 to 49.57; 1 study, 43 participants; low-certainty evidence) components of the Endometriosis Health Profile-30, and both the emotional component (MD 32.30, 95% CI 13.16 to 51.44; 1 study, 43 participants; low-certainty evidence) and the physical component of the 12-item Short Form (MD 22.90, 95% CI 10.97 to 34.83; 1 study, 43 participants; low-certainty evidence) when compared to diagnostic laparoscopy. We are uncertain of the safety of adhesiolysis compared to comparator groups due to low-certainty evidence and lack of structured adverse event reporting. No studies reported on psychological outcomes or requirements for analgesia. Laparoscopic uterosacral ligament ablation or resection compared to diagnostic laparoscopy/other treatment We are uncertain of the effect of laparoscopic uterosacral ligament/nerve ablation (LUNA) or resection compared to other treatments postoperatively at three months (OR 1.26, 95% CI 0.40 to 3.93; 1 study, 51 participants; low-certainty evidence) and six months (MD -2.10, 95% CI -4.38 to 0.18; 1 study, 74 participants; very low-certainty evidence). At 12 months post-surgery, we are uncertain of the effect of LUNA on the rate of successful treatment compared to diagnostic laparoscopy. One study of 56 participants found no difference in the effect of LUNA on non-cyclical pain (P = 0.854) or dyspareunia (P = 0.41); however, there was a difference favouring LUNA on dysmenorrhea (P = 0.045) and dyschezia (P = 0.05). We are also uncertain of the effect of LUNA compared to vaginal uterosacral ligament resection on pelvic pain at 12 months (MD 2.00, 95% CI 0.47 to 3.53; 1 study, 74 participants; very low-certainty evidence). We are uncertain of the safety of LUNA or resection compared to comparator groups due to the lack of structured adverse event reporting. Women undergoing LUNA may require more analgesia postoperatively than those undergoing other treatments (P < 0.001; 1 study, 74 participants). No studies reported psychological outcomes or QoL.
AUTHORS' CONCLUSIONS
We are uncertain about the benefit of adhesiolysis or LUNA in management of pain in women with CPPS based on the current literature. There may be a QoL benefit to adhesiolysis in improving both emotional wellbeing and social support, as measured by the validated QoL tools. It was not possible to synthesis evidence on adverse events as these were only reported narratively in some studies, in which none were observed. With the inadequate objective assessment of adverse events, especially long-term adverse events, associated with adhesiolysis or LUNA for CPPS, there is currently little to support these interventions for CPPS.
Topics: Chronic Pain; Endometriosis; Female; Humans; Laparoscopy; Pelvic Pain; Quality of Life
PubMed: 34923620
DOI: 10.1002/14651858.CD008212.pub2