[Laparoscopic findings in women with chronic pelvic pain].

OBJECTIVE: To determine the frequency and analyze the findings during laparoscopy in women with chronic pelvic pain /CPP/. MATERIALS AND METHODS: The study was conducted in the period 01.03.2004-01.07.2007 in the Gynaecological clinic at the Department of Obstetrics and Gynaecology, MU-Pleven. Eighty-six women were consecutively admitted in the Clinic, presenting with pelvic pain with duration more than 6 months and who underwent laparoscopy in order to be diagnostically defined more accurately or operatively treated. They were classified according to their socio-demographic characteristics, reproductive history/fertility and parity/, presence of preceding operative interventions, and findings during laparoscopy. RESULTS AND DISCUSSION: The most frequent findings in women with CPP during laparoscopy were endometriosis /56,98%/ and adhaesion syndrome /39,53%/, and with a lower frequency-pelvic varicosis /17.44%/ and Allen-Masters syndrome /24,42%/. The most common localization of endometriotic foci was on ovaries/40,7%/and plica vesicouterina /18,6 %/, and of the varicose dilated veins-along vv.ovaricae and in the basis of the broad ligaments/resp. 89,96 and 60%/. CONCLUSION: Laparoscopy is an exceptionally valuable and useful method in diagnosing and differentiating the etiology of chronic pelvic pain symptoms, because of the frequent presence of more than one cause with pelvic localization for its appearance.

[Frequency of gynecological morbidity and chronic pelvic pain in the Gynecological Clinic, UMPHAT "Dr. G. Stransky" - Pleven].

OBJECTIVE: By setting the structure of gynaecological morbidity to determine the frequency of chronic pelvic pain /CPP/ and the most common diseases, presented with CPP. MATERIALS AND METHODS: A prospective study was conducted in the Gynaecological Clinic at the Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004-01.07.2007. During that period, 4168 women were consecutively admitted in the Clinic. The object of the study were patients with leiomyomatosis /L/, endometriosis /E/, adenomyosis /A/, pelvic congestion syndrome/PCS/, Allen-Masters syndrome/AMS/, pelvic inflammatory disease /PID/ and adhesion syndrome /AS/. They were divided in groups according to age, type of disease and presence of CPP. The following methods were used for the purpose of the study: documentary method, R-AFS classification of E, inquiry method-by a questionnaire/form/, based on instruments for pain assessment, which are accepted worldwide /visual analogue scale, etc. RESULTS AND DISCUSSION: Among all 1357 women included in the study, the most common diseases were L, followed by E and A, and AS. Comparatively lower frequency was determined for PCS and AMS. In almost one-third of the women in the study were admitted in the Clinic for diagnostic specification or operative treatment because of CPP. The most frequently defined reason for it were E, L and AS, and in a smaller part of patients-PCS and AMS. CONCLUSION: From the analysis we made, we concluded that CPP was very often polyetiologically determined, which was assessed by some invasive methods.

[Therapeutical management of the most frequent gynaecological diseases and chronic pelvic pain in the Gynaecological Clinic, UMPHAT "Dr. G. Stransky"-Pleven in the period 2004-2007].

OBJECTIVE: To determine the trend in application of the basic therapeutical procedures in the most common gynaecological diseases combined or not with chronic pelvic pain /CPP/. MATERIALS AND METHODS: In the prospective study conducted in the Gynaecological Clinic at the Department of Obstetrics and Gynaecology, MU-Pleven in the period 01.03.2004-01.07.2007, 1356 women with leiomyomatosis /L/, endometriosis /E/, adenomyosis /A/, pelvic congestion syndrome /PCS/, Allen-Masters syndrome /AMS/, pelvic inflammatory disease /PID/ and adhaesion syndrome /AS/, were included in it. They were grouped according to their age, type of disease, presence of CPP, type of therapeutical procedure and histological verification of the condition. For the purpose of the study the following methods were used: documentary method, R-AFS classification of E, inquiry method-by a questionnaire /form/, based on instruments for pain assessment, accepted worldwide. RESULTS AND DISCUSSION: The highest frequency was determined for L, E and A, and AS. In the majority of the total number of consecutively admitted patients with those diseases an operative intervention was done, and almost one-sixth of women underwent conservative treatment. The same trend was observed in patients with chronic pain symptomatic, regarding their operative and conservative management. Histological verification of the condition was closely related with etiological reason and diagnostic approach. CONCLUSION: A balance between conservative and operative treatment should be set in the basis of therapeutical management, consistent with modern diagnostic procedures. Determination of the trend in treatment of women with CPP will lead to falling off of indiscriminate application of operative methods prior to exact diagnostic specification and setting of multidisciplinary approach. That will serve as a background for the future conduct to that group of patients.