Complex neurophysiological algorithm for pudendal nerve neuropathy for descending perineum syndrome

Abstract

Aim: to improve diagnostics for descending perineum syndrome.Patients and Methods: the prospective cohort study included 127 patients (85 (66.9%) — females), aged 49.9 ± 14.4 years with descending perineum syndrome. All patients had proctogenic constipation, anal incontinence and/or chronic neurogenic pelvic pain. All patients underwent a neurophysiological examination according to the original complex pudendal nerve terminal motor latency (PNTML) method — neurophysiological protocol for detection of the pelvic floor muscles innervation disorders.Results: the latency of the M-response of the pudendal nerve increased on at least one side in 85 (66.9%) patients (50 women and 35 men). The use of a new complex neurophysiological diagnostic protocol made it possible to identify signs of pudendal neuropathy in 29.9% of patients. The incidence of neuropathy in patients with clinically significant perineal prolapse syndrome was 96.5% in females and 97.6% in males.Conclusion: the new complex neurophysiological diagnostic algorithm made it possible to identify disorders of innervation along the efferent pathway in the Alcock’s canal and distally in 85 (66.9%) cases, along the efferent pathway proximal to the Alcock’s canal — in 23 (18.1%); a combination of efferent and afferent disturbances occurred in 15 (11.8%).