Effectiveness of Laparoscopic Uterosacral Nerve Ablation for Chronic Pelvic Pain :A Case Report

The prevalence of chronic pelvic pain (CPP) in women of reproductive age is estimated to be 4-16 ％. Its treatment is often challenging. Evidence supporting the use of laparoscopic uterosacral nerve ablation (LUNA) for CPP is limited. Herein, we report a case of CPP effectively treated with LUNA.A 26-year-old Japanese woman presented with dysmenorrhea and was referred to our hospital. As the structural diseases associated with dysmenorrhea were not evident upon gynecological examination or transvaginal ultrasound, the patient was diagnosed with functional dysmenorrhea. Her symptoms improved after initiating treatment with dienogest. However, she subsequently developed left-sided pelvic pain that progressively worsened. Severe tenderness was noted on the left side of the Douglas pouch. Magnetic resonance imaging suggested pelvic adhesions. However, diagnostic laparoscopy revealed no pelvic adhesions. Instead, findings indicative of endometriosis, such as a peritoneal defect and redness on the left uterosacral ligament, were observed.The mobility of the left uterosacral ligament was limited ; therefore, we performed LUNA. Her CPP markedly decreased from the day following the operation, with no subsequent exacerbation observed.Previous studies reported that LUNA can reduce CPP in patients with mild endometriosis and limited uterosacral ligament mobility. LUNA may be a treatment option for CPP if optimal cases in which the procedure is likely to be effective are carefully selected. Shinshu Med J 73 : 235―239, 2025