ISSN: 2474-9230
Authors: Kaur KK*
Having earlier reviewed pain correlated endometriosis here newer insight received in tackling these severe incapacitating pain which we encounter in routine practice for tackling patients impacted in view of their incapability of working. Recently Pinsard M, et al. conducted an experimental study. Where they dissected the pelvises of 4 human female foetuses into serial sections, followed by treatment with hematoxylin and eosin staining prior to immune staining. They detected nerves (S100 þ) and characterized the kinds of nerves. The slices derived had an alignment for the construction of a 3-dimensional (3D) model. On the constructed 3D model, the nerve fibers apparently possessed a centripetal path from the uterine serosa to the endometrium. Amongst the myometrium, enrichment of density of innervation was found. Endometrial innervation was scanty however was existent in the functional layer of the endometrium. In toto maximum abundance of innervation was existent in the supravaginal cervix and sparse in the body of the uterus. Innervation was laterally to the cervix adjacent to the parametrium and paracervix. Four kinds of nerve fibers were isolated: autonomic sympathetic (THþ), parasympathetic (VIPþ), and sensitive (NPYþ), (CGRP1þ) and (VIPþ). They were observed in the 3 parts and the 3 layers of the uterus. Thus concluding how a constructed 3D model of human uterine innervation model might yield a robust base for assessment of uterine innervation in pathologic situations, for finding newer therapeutic strategies. For gaining greater insight regarding the physiology of pain in pelvic pain pathological situations, like endometriosis, in which changes of uterine innervation have been emphasized, they conducted an anatomic & functional mapping of the macro & micro innervation of human uterus to provide a 3-D reconstruction model of uterine innervation. This would help us in planning innovative therapeutic strategies for incapacitating pain in endometriosis cases with repeated endometriosis surgeries& quality of life (QOL).
Keywords: Pelvic Innervation; Chronic Pelvic Pain; Laparoscopic Uterosacral Nerve Ablation; Presacral Neurectomy
