The Association between Endometriosis Appearance during Laparoscopic Surgery and Pain Characteristic in Pelvic Endometriosis

Abstract

The Association between Endometriosis Appearance during Laparoscopic Surgery and Pain Characteristic in Pelvic Endometriosis Hubungan Tampilan Susukan Endometriosis pada saat Pembedahan Laparoskopik dengan Karakteristik Nyeri pada Endometriosis Pelvik Herbert Situmorang, Renny L Avriyani, Eka R Gunardi Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia Dr. Cipto Mangunkusumo General Hospital Jakarta Abstract Abstrak Objective : To evaluate the correlation between the American Society of Reproductive Medicine (ASRM) score in endometriosis and severity pelvic pain in a group of women with endometriosis. Tujuan : Untuk mencari hubungan antara skor endometriosis ASRM dan karakteristik nyeri pelvik pada pasien endometriosis Methods : A total of 131 patients with pelvic pain who: conduct laparoscopy for diagnosis and therapy of endometriosis, have pain symptoms>3 months, and absence of pelvic anomalies. Dysmenorrhea, deep dyspareunia, dyschezia, dysuria, and chronic pelvic pain were evaluated using a 10-point visual analogue scale. The data was collected by assessing the medical record, and retrospective analysis was performed. Disease stage according to the American Society of Reproductive Medicine, the presence of adhesion, lesion type (Deep Infi ltrating Endometriosis (DIE) or without DIE), and severity of pain symptoms were analysed by Spearman analysis. Different VAS between DIE vs non DIE group was analysed by Mann-Whitney analysis. Metode : Sebanyak 131 pasien dengan nyeri pelvik yang menjalani laparoskopi untuk diagnosis dan terapi endometriosis, memiliki nyeri > 3 bulan, dan tidak mengalami kelainan organ pelvis. Dilakukan evaluasi terhadap dismenorea, dispareunia dalam, diskezia, disuria, dan nyeri pelvic kronik dengan menggunakan nilai 1-10 dari skala analog visual. Penelitian ini dilakukan di Rumah Sakit Umum Pusat Rujukan Nasional Dr. Cipto Mangunkusumo, Jakarta. Stadium endometriosis berdasarkan American Society of Reproductive Medicine, kejadian adhesi, jenis lesi (ada Endometriosis Susukan Dalam/ESD atau tanpa ESD), dan derajat keparahan nyeri dianalisis dengan analisis Spearman. Perbedaan skala nyeri antara ESD dan non ESD dianalisis dengan metode Mann-Whitney. Results : Stage IV endometriosis accounts for 79.4%. Based on the macroscopic appearance, ovarian endometriosis accounts for 92.4%, peritoneal endometriosis 82.4%, DIE was 40.5%, and adenomyosis was 19.1%. There was signifi cant correlation between total ASRM, ovarian endometriosis, peritoneal lesion, Douglas pouch obliteration, adnexal adhesion score and VAS dysmenorrhea (r=0.303; 0.187; 0.203; 0.278; 0.266, p<0.05). There was signifi cant VAS difference of DIE vs non DIE group; the difference was on dyspareunia (5.18±2.4 and 4.58±1.0, p<0.001] and dyschezia [5.28±2.2 and 4.86±0.7,p<0.001] Hasil : Sebanyak 79,4% pasien tergolong ke dalam endometriosis stadium IV. Berdasarkan tampilan makroskopik, endometriosis ovarium terdapat pada 92,4%, endometriosis peritoneal 82,4%, ESD 40,5%, dan adenomiosis pada 19,1%. Terdapat korelasi positif bermakna antara skor ASRM total, sub-skorkista endometriosis, endometriosis superfi sial, obliterasi kavum douglas, dan adhesi adheksa dengan VAS dismenorea (r=0,303; 0,187; 0,203; 0,278; 0,266, p<0,05). Pada kelompok ESD dan tanpa ESD, didapatkan perbedaan VAS dismenorea, dispareunia dalam, diskezia, dan nyeri pelvic kronik yang bermakna (6,13±1.7 dan 5,95±1,7, p = 0,560 ; 5,18±2.4 dan 4,58±1,0, p < 0,001; 5,28±2,2 dan 4,86±0,7 , p < 0,001; 2,20±2,8 dan 0,60±1,8, p <0,001) Conclusions : There was a positive correlation between ovarian endometriosis score and severity of dysmenorrhea. There was also a difference in the degree of endometriosisassociated pain between DIE and non DIE group. Kesimpulan : Terdapat korelasi positif bermakna antara skor ASRM dengan VAS dismenorea. Terdapat perbedaan Keywords : endometriosis, deep infi ltrating endometriosis, dysmenorrhea, dyspareunia, dyschezia VAS dismenorea, dyspareunia dalam, diskezia, dan nyeri pelvic kronik pada kelompok ESD dan tanpa ESD Kata kunci : endometriosis, endometriosis susukan dalam, dismenorea, dispareunia dalam, diskezia