The Efficacy of Presacral Neurectomy for the Relief of Midline Dysmenorrhea

TLDR

The study prospectively evaluated the efficacy of presacral neurectomy for treating midline dysmenorrhea. The study included patients with moderate to severe dysmenorrhea and stage III–IV endometriosis. Presacral neurectomy resulted in pain‑free status in 15 of 17 patients over 42 months, whereas endometriosis resection alone yielded no relief, supporting its high efficacy for dysmenorrhea and suggesting failures stem from patient selection or incomplete nerve resection.

Abstract

The present study was undertaken to evaluate prospectively the efficacy of presacral neurectomy for the treatment of midline dysmenorrhea. All patients had moderate to severe dysmenorrhea and stage III-IV endometriosis. Of the patients undergoing presacral neurectomy (N = 17), only two had a recurrence of pain. The remainder of the patients undergoing presacral neurectomy remain pain-free at 42 months of follow-up. Of the patients undergoing resection of endometriosis but not presacral neurectomy (N = 9), none received relief of midline pain. Relief of lateral pain, back pain, and dyspareunia was variable in both groups. Our findings corroborate previous retrospective studies showing that presacral neurectomy is highly effective in the treatment of dysmenorrhea. We speculate that the most common reasons for failure of presacral neurectomy are inappropriate selection of patients and incomplete resection of the presacral nerve plexus.