The pathogenesis of pelvic pain in external genital endometriosis. Treatment options

• Mekan R. Orazov
• Demyashkin G.A.
• Marina B. Khamoshina
• Zakirova Ya.R.
• Zharkov N.V.
• Batov M.A.

Abstract

Still genital endometriosis continues to remain a mystery of the century, trying to guess which leading scientists from all over the world. One of the most common forms of genital endometriosis is external genital endometriosis (EGE), the leading clinical symptom is chronic pelvic pain. Pathogenetic mechanisms of the pain syndrome in EGE remain unclear and require further study.

The aims - to expand understanding of the pathogenesis of pelvic pain with external genital endometriosis and to evaluate the efficacy of treatment with dienogest.

Material and methods. The research design included two stagesJhe study included 42 (n=42) patients of reproductive age (mean age 35±5 years) applied for surgical treatment with the diagnosis of EGE. Inner-vational the unit studied by immunohistochemical method (IHC) and polymerase chain reaction in real time (PCR-RV). As primary antibodies were used mouse monoclonal antibodies to NSE, S100 and PGP 9.5. The second phase of the study was devoted to the evaluation of clinical effectiveness of therapy for pelvic pain patients in the study cohort was 60 (n=60).

The results of the study showed that the number of neuronal apudocytes with a positive reaction with antibodies to neuron-specific enolase (NSE) was significantly higher in patients with pain syndrome in EGE (28.7±3.1%) in comparison with the group without pain (15.6±2.4%) (p<0.05).

Analysis of expression level of S100 protein in the myelin nerve fibers (limiited) and their density (fibres/mm²) was significantly higher in the intervention group and 0.36+0.11, in contrast to that in the group of morphological control 0.11+0.09 (p<0.05). The expression of PGP 9.5 was significantly higher in the group of patients with severe pelvic pain on a background of NGE and was 1.26+0.01 compared to the group of mor­phological control 0.8+0.21 (p<0.05).

Conclusions. In the basis of neurogenesis pelvic pain due to external genital endometriosis, in comparison with the painless form of is the increase in the expression of neuronal apudocytes 2 times (p<0.05), demyelination of lemmocytes 3.2 times (p<0.05), an increase in the density of nerve fibers in endometriotic lesions around 1.6 times that in the aggregate determines the increase in the number and sensitivity of nociceptors (p<0.05) and is one of the key triggers the formation of endometriosis-associated pelvic pain. Pathogenetically treatment of pelvic pain with external genital endometriosis should be considered as the application dienogest having the ability to inhibit the processes of proliferation, inflammation, angio- and neurogenesis.

Keywords:neurogenesis, endometriosis, nociceptors, lemmocytes, dienogest

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