Naomi Min, Peter Thiel, Meghan McGrattan, Emiel Post Uiterweer, John Matelski, Chris Walsh, Judith Huirne, Ally Murji
{"title":"剖宫产疤痕位与盆腔疼痛：一项系统回顾和荟萃分析。","authors":"Naomi Min, Peter Thiel, Meghan McGrattan, Emiel Post Uiterweer, John Matelski, Chris Walsh, Judith Huirne, Ally Murji","doi":"10.1016/j.jmig.2025.07.006","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Pain is a long-accepted but inadequately explored symptom of cesarean scar niche (CSN) and it is important to systematic assess the prevalence and features of pelvic pain associated with CSN, also referred to as cesarean scar defect or isthmocele. The purpose of this study is to evaluate the association between CSN and pelvic pain.</p><p><strong>Data sources: </strong>A comprehensive strategy was used to search MEDLINE, EMBASE, Pub Med, Cochrane CENTRAL, and CINAHL from database inception to February 20<sup>th</sup>, 2025 .</p><p><strong>Methods of study selection: </strong>We included randomized controlled trials, prospective and retrospective cohorts, and case series involving symptomatic patients with a radiological diagnosis of CSN that evaluated pain as an outcome. Risk of bias was assessed with the Robins-I tool. The protocol was registered in PROSPERO (CRD42022346443).</p><p><strong>Tabulation, integration and results: </strong>The primary outcome was prevalence of pelvic pain in patients with confirmed CSN. Other outcomes included the risk of pain in patients with CSN compared those without, and changes in pain symptoms following medical or surgical management of niche. Sixty-four studies reported on pain (dysmenorrhea, dyspareunia, chronic pelvic pain (CPP), suprapubic pain (SPP)) in patients with CSN. Patients with a CSN were at increased risk of dysmenorrhea (RR 2.25, 95%CI 0.90-5.63), dyspareunia (RR 2.06 95%CI 1.42-2.99), and CPP (2.72, 95%CI 1.63-4.54) compared to those without. In patients with confirmed niche, the prevalence of dysmenorrhea was 38.2% (95%CI 28.8-48.6); dyspareunia 28.2% (95%CI 15.3-46.0); CPP 26.8% (95%CI 18.6-36.9) and SPP 32.5% (95%CI 18.6-36.9). Both medical and surgical treatment of CSN significantly reduced pain symptoms (OR 0.13, 95%CI 0.08-0.23). Most studies were high risk for measurement bias due to lack of standardization for outcome measures.</p><p><strong>Conclusion: </strong>There is a strong association between CSN and various pelvic pain symptoms. Future studies require standardization of nomenclature and reporting for pain in this context.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Cesarean scar niche and pelvic pain: A systematic review and meta-analysis.\",\"authors\":\"Naomi Min, Peter Thiel, Meghan McGrattan, Emiel Post Uiterweer, John Matelski, Chris Walsh, Judith Huirne, Ally Murji\",\"doi\":\"10.1016/j.jmig.2025.07.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Pain is a long-accepted but inadequately explored symptom of cesarean scar niche (CSN) and it is important to systematic assess the prevalence and features of pelvic pain associated with CSN, also referred to as cesarean scar defect or isthmocele. The purpose of this study is to evaluate the association between CSN and pelvic pain.</p><p><strong>Data sources: </strong>A comprehensive strategy was used to search MEDLINE, EMBASE, Pub Med, Cochrane CENTRAL, and CINAHL from database inception to February 20<sup>th</sup>, 2025 .</p><p><strong>Methods of study selection: </strong>We included randomized controlled trials, prospective and retrospective cohorts, and case series involving symptomatic patients with a radiological diagnosis of CSN that evaluated pain as an outcome. Risk of bias was assessed with the Robins-I tool. The protocol was registered in PROSPERO (CRD42022346443).</p><p><strong>Tabulation, integration and results: </strong>The primary outcome was prevalence of pelvic pain in patients with confirmed CSN. Other outcomes included the risk of pain in patients with CSN compared those without, and changes in pain symptoms following medical or surgical management of niche. Sixty-four studies reported on pain (dysmenorrhea, dyspareunia, chronic pelvic pain (CPP), suprapubic pain (SPP)) in patients with CSN. Patients with a CSN were at increased risk of dysmenorrhea (RR 2.25, 95%CI 0.90-5.63), dyspareunia (RR 2.06 95%CI 1.42-2.99), and CPP (2.72, 95%CI 1.63-4.54) compared to those without. In patients with confirmed niche, the prevalence of dysmenorrhea was 38.2% (95%CI 28.8-48.6); dyspareunia 28.2% (95%CI 15.3-46.0); CPP 26.8% (95%CI 18.6-36.9) and SPP 32.5% (95%CI 18.6-36.9). Both medical and surgical treatment of CSN significantly reduced pain symptoms (OR 0.13, 95%CI 0.08-0.23). Most studies were high risk for measurement bias due to lack of standardization for outcome measures.</p><p><strong>Conclusion: </strong>There is a strong association between CSN and various pelvic pain symptoms. Future studies require standardization of nomenclature and reporting for pain in this context.</p>\",\"PeriodicalId\":16397,\"journal\":{\"name\":\"Journal of minimally invasive gynecology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2025-07-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of minimally invasive gynecology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jmig.2025.07.006\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of minimally invasive gynecology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jmig.2025.07.006","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
Cesarean scar niche and pelvic pain: A systematic review and meta-analysis.
Objective: Pain is a long-accepted but inadequately explored symptom of cesarean scar niche (CSN) and it is important to systematic assess the prevalence and features of pelvic pain associated with CSN, also referred to as cesarean scar defect or isthmocele. The purpose of this study is to evaluate the association between CSN and pelvic pain.
Data sources: A comprehensive strategy was used to search MEDLINE, EMBASE, Pub Med, Cochrane CENTRAL, and CINAHL from database inception to February 20th, 2025 .
Methods of study selection: We included randomized controlled trials, prospective and retrospective cohorts, and case series involving symptomatic patients with a radiological diagnosis of CSN that evaluated pain as an outcome. Risk of bias was assessed with the Robins-I tool. The protocol was registered in PROSPERO (CRD42022346443).
Tabulation, integration and results: The primary outcome was prevalence of pelvic pain in patients with confirmed CSN. Other outcomes included the risk of pain in patients with CSN compared those without, and changes in pain symptoms following medical or surgical management of niche. Sixty-four studies reported on pain (dysmenorrhea, dyspareunia, chronic pelvic pain (CPP), suprapubic pain (SPP)) in patients with CSN. Patients with a CSN were at increased risk of dysmenorrhea (RR 2.25, 95%CI 0.90-5.63), dyspareunia (RR 2.06 95%CI 1.42-2.99), and CPP (2.72, 95%CI 1.63-4.54) compared to those without. In patients with confirmed niche, the prevalence of dysmenorrhea was 38.2% (95%CI 28.8-48.6); dyspareunia 28.2% (95%CI 15.3-46.0); CPP 26.8% (95%CI 18.6-36.9) and SPP 32.5% (95%CI 18.6-36.9). Both medical and surgical treatment of CSN significantly reduced pain symptoms (OR 0.13, 95%CI 0.08-0.23). Most studies were high risk for measurement bias due to lack of standardization for outcome measures.
Conclusion: There is a strong association between CSN and various pelvic pain symptoms. Future studies require standardization of nomenclature and reporting for pain in this context.
期刊介绍：
The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.
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