Preoperative pain measurements in correlation to deep endometriosis
classification with Enzian.
Abstract
Objective To study pain symptoms and their correlation with the
anatomical location (and extent) of deep endometriosis lesion(s)
classified by the Enzian score. Design Prospective multi-centre study
Setting Web-based application called EQUSUM (www.equsum.org) to classify
and report surgical procedures Population or Sample A total of 419
surgical DE (deep endometriosis) cases Methods Collection of surgical
data in DE cases and their endometriosis classification and pain scores.
Main Outcome Measures Preoperative reported pain scores in each domain
(dysmenorrhea, dyschezia, dysuria, dyspareunia, chronic pelvic pain)
were collected along with the Enzian classification. Baseline
characteristics, pain scores, surgical procedure and extent of the
disease were also collected. Results In general, more extensive
involvement of DE does not lead to an increase in numerical rating scale
for pain measures. However, dysuria and bladder involvement do show a
clear correlation AUC 0.62 (SE 0.04, CI 0.54-0.71, p< 0.01).
Regarding the predictive value of dyschezia, we found a weak, but
significant correlation with ureteric involvement; AUC 0.60 (SE 0.04, CI
0.53-0.67, p< 0.01). Conclusions Pain symptoms poorly
correlate with anatomical locations of deep endometriosis in almost all
pain scores, with the exception of bladder involvement and dysuria which
did show a correlation. Also dyschezia seems to have predictive value
for DE ureteric involvement and therefore MRI or ultrasound imaging
(ureter and kidney) is recommended in the preoperative workup in these
patients.