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Ashon Sa’adi et al

occasional patient will report alteration of the sensation of DISCUSSION
bladder fullness due to interruption of sympathetic fibers Comparisons between LUNA and PSN
carrying bladder sensation. Some patients may report a decrease
of vaginal lubrication with sexual arousal. Constipation is not a In a randomized study, Tjaden, et al., 1990; Candiani, et al; 1992;
predictable consequence of presacral neurectomy since the Zullo, et al., 2003 have been published three randomized
parasympathetic fibers which stimulate evacuation of the controlled trials using PSN along with other surgical treatment
rectosigmoid pass through the inferior hypogastric plexus (also of endometriosis. 22,24,27 A randomized controlled trial comparing
termed the pelvic plexus) and are not interrupted by PSN. Chen outcomes of PSN to LUNA has also been published Chen FP,
FP, Soong YK,1997: There are 485 (74%) of 655 patients com- et al 1996. The comparison between laparoscopic presacral
plained of constipation after laparoscopic presacral neurectomy, neurectomy (LPSN) and LUNA for control of primary
which was relieved easily by medication. There were 0.6% dysmenorrhea showed effectiveness of 87.9% and 82.9%,
major complications that required further surgery, including respectively, at the 3-month postoperative follow-up, whereas,
injury of the right internal iliac artery and chylous ascites. And long-term LPSN was shown to be more effective than LUNA
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0.5% cases had laceration of the middle sacral vein controlled (81.8% vs 51.4 % at the 12-month visit). Another study
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during laparoscopy. Chen FP, Soong YK, 1997 (Table 1). In showed that the efficacy of LUNA declined from 72% in the
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patients undergoing laparoscopic PSN, follow-up observation first year to 39% in the fourth year. However, only PSN but
has shown evidence of long-term efficacy, similar to that seen not LUNA was beneficial for alleviating secondary dys-
after laparotomy PSN. 21,22 menorrheal associated with endometriosis in some randomized
RESULTS
TABLE 1: The randomized controlled trials using LUNA or PSN for surgical treatment of pain management have been published

Author Year Patients Result of research Others
Litchen E, et al 23 1987 21 Decrease efficacy 4th year LUNA LUNA 1st and 4th year
Tjaden, et al. 22 1990 26 There is some evidence of LUNA vs control of no
the effective treatment
Candiani, et al. 24 1992 71 No statistically significant More complication
differences RCT
Chapron C, et al 25 1996 21 94% improvement of pain LUNA deep endometriosis
Chen FP, Chang, et al. 26 1996 68 PSN was better in 1 year PSN and LUNA
Chen FP, Soong YK et al 20 1997 655 Significant for 12th month
RCT PSN more complication
Zullo, et al. 27 2003 141 More effective PSN, PSN and LUNA
RCT
Soysal ME, et al 28 2003 15 Significant resolusi pain Baseline and PSN
and sexual 3,6,12 months
Prospective observational
Vercellini, et al. (29) 2003 180 Recurrent dysmenorrhea LUNA for pain endometriosis
was similar for both groups
RCTL
Johnson NP, et al. 30 2004 123 Significant reduction of LUNA and medicine
dysmenorrheal.
No significant difference in RCT
non-menstrual pelvic pain, deep
dyspareunia or dyschezia
Proctor, et al, 6 2005 Data Collection No significant symptom by Case : Primary dysmenorhea
and Meta-analysis: LUNA-PNS
7 RCTs Unuseful Endometriosis
Juang, et al 31 2006 12 Increase in satisfactory rate 3th LUNA for deep dyspareunia
and decrease in 12th months Pilot study
prospective observational
Latthe PM, et al 32 2007 Data collection and LUNA still effective LUNA vs No surgical
Meta-analysis: PSN more effective LUNA vs PSN
9 RCTs Not significant in
endometriosis
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