Khalife Tarek, Hagen Amy M, Alm Jessica E C
Obstetrics and Gynecology, Mayo Clinic Health System - Southwest Minnesota region, Mankato, MN, USA.
Obstetrics and Gynecology, Mayo Clinic Health System - Southwest Minnesota region, Mankato, MN, USA.
Sex Med Rev. 2022 Oct;10(4):529-542. doi: 10.1016/j.sxmr.2022.06.009. Epub 2022 Sep 8.
Women with pelvic pain commonly report pain in their ovaries, vagina, uterus, or bladder. These symptoms may be caused by visceral genitourinary pain syndromes but also may be caused by musculoskeletal disorders of the abdomen and pelvis. Understanding neuroanatomical and musculoskeletal factors that may contribute to genitourinary pain is important for evaluation and management.
This review aims to (i) highlight the importance of clinical knowledge of pelvic neuroanatomy and sensory dermatomal distribution of the lower abdomen, pelvis, and lower extremities, exemplified in a clinical case; (ii) review common neuropathic and musculoskeletal causes of acute and chronic pelvic pain that may be challenging to diagnose and manage; and (iii) discuss female genitourinary pain syndromes with a focus on retroperitoneal causes and treatment options.
A comprehensive review of the literature was performed by searching the PubMed, Ovid Embase, MEDLINE, and Scopus databases using the keywords "chronic pelvic pain," "neuropathy," "neuropathic pain," "retroperitoneal schwannoma," "pudendal neuralgia," and "entrapment syndromes."
Retroperitoneal causes of genitourinary pain syndromes have substantial overlap with common conditions treated in a primary care setting. Thus, a comprehensive and systematic history and physical examination, with focused attention to the pelvic neuroanatomy, is key to establishing the correct diagnosis. In the clinical case, such a comprehensive approach led to the unexpected finding of a large retroperitoneal schwannoma. This case highlights the intricacy of pelvic pain syndromes and the complex nature of their possible overlapping causes, which ultimately affects treatment planning.
Knowledge of the neuroanatomy and neurodermatomes of the abdomen and pelvis, in addition to understanding pain pathophysiology, is critical when evaluating patients with pelvic pain. Failure to apply proper evaluation and implement proper multidisciplinary management strategies contributes to unnecessary patient distress, decreased quality of life, and increased use of health care services. Khalife T, Hagen AM, Alm JEC. Retroperitoneal Causes of Genitourinary Pain Syndromes: Systematic Approach to Evaluation and Management. Sex Med Rev 2022;10:529-542.
患有盆腔疼痛的女性通常会报告卵巢、阴道、子宫或膀胱疼痛。这些症状可能由内脏泌尿生殖系统疼痛综合征引起，但也可能由腹部和骨盆的肌肉骨骼疾病引起。了解可能导致泌尿生殖系统疼痛的神经解剖学和肌肉骨骼因素对于评估和管理至关重要。
本综述旨在（i）通过一个临床病例举例，强调盆腔神经解剖学以及下腹、骨盆和下肢感觉皮节分布的临床知识的重要性；（ii）回顾急性和慢性盆腔疼痛常见的神经性和肌肉骨骼性病因，这些病因可能在诊断和管理方面具有挑战性；（iii）讨论女性泌尿生殖系统疼痛综合征，重点关注腹膜后病因和治疗选择。
通过使用关键词“慢性盆腔疼痛”“神经病变”“神经性疼痛”“腹膜后神经鞘瘤”“阴部神经痛”和“卡压综合征”检索PubMed、Ovid Embase、MEDLINE和Scopus数据库，对文献进行全面综述。
泌尿生殖系统疼痛综合征的腹膜后病因与初级保健环境中治疗的常见病症有很大重叠。因此，全面系统的病史和体格检查，并重点关注盆腔神经解剖学，是确立正确诊断的关键。在该临床病例中，这种全面的方法导致意外发现一个巨大的腹膜后神经鞘瘤。该病例突出了盆腔疼痛综合征的复杂性及其可能重叠病因的复杂性质，这最终会影响治疗计划。
在评估盆腔疼痛患者时，除了解疼痛病理生理学外，了解腹部和骨盆的神经解剖学和神经皮节也至关重要。未能进行适当评估和实施适当的多学科管理策略会导致患者不必要的痛苦、生活质量下降以及医疗服务使用增加。哈利菲T、哈根AM、阿尔姆JEC。泌尿生殖系统疼痛综合征的腹膜后病因：评估和管理的系统方法。性医学评论2022；10：529 - 542。
