MP21-10 WHEN GENITO-PELVIC DYSESTHESIA DOES NOT ORIGINATE IN THE GENITO-PELVIC REGION: MANAGEMENT OF PATIENTS WITH SACRAL RADICULOPATHY

Abstract

You have accessJournal of UrologyCME1 May 2022MP21-10 WHEN GENITO-PELVIC DYSESTHESIA DOES NOT ORIGINATE IN THE GENITO-PELVIC REGION: MANAGEMENT OF PATIENTS WITH SACRAL RADICULOPATHY Irwin Goldstein, Choll Kim, Sue Goldstein, Maria Uloko, Noel Kim, and Barry Komisaruk Irwin GoldsteinIrwin Goldstein More articles by this author , Choll KimCholl Kim More articles by this author , Sue GoldsteinSue Goldstein More articles by this author , Maria UlokoMaria Uloko More articles by this author , Noel KimNoel Kim More articles by this author , and Barry KomisarukBarry Komisaruk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002554.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urologists encounter both women and men who experience unwanted persistent, distressing, atypical sensations such as arousal (including erection, burning, itching, pain in the clitoris/penis and other genito-pelvic regions (e.g. vulva/scrotum, pelvic floor, bladder, urethra, perineal/perianal region, prostate). Genito-pelvic dysesthesia (GPD) is usually thought to emanate from pathology in the end organ (e.g., clitoris/penis) or pelvis/perineum (e.g., pelvic floor or pudendal nerve). Recently GPD has been shown to be associated with sacral radiculopathy from annular tear lumbosacral disc pathology impacting the cauda equina. In such cases, the GPD may be a result of nerve root irritation in the cauda equina producing sensations perceived as originating in the peripheral genito-pelvic region. This is analogous to sciatica where pain is perceived in the lower extremities but is commonly the result of “upstream” cauda equina pathology. We utilized a novel management algorithm to identify GPD patients with sacral radiculopathy from annular tear lumbosacral disc disease who underwent spine surgery and evaluated their long-term outcome. METHODS: A chart review of patients with GPD who underwent spine surgery between 2016 and 2019 was performed. The management algorithm involved ruling out pathology in the genito-pelvic regions; identifying pathology in the cauda equina on lumbosacral MRI; finding abnormal neurogenital testing of the pudendal/sciatic nerves; having a positive diagnostic response to a transforaminal epidural spinal injection; and undergoing lumbar endoscopic spine surgery. All patients had at least 1 year follow-up post-spine surgery. Treatment outcome was based on the Patient Global Impression of Improvement (PGI-I), measured every 3 months post-operatively. RESULTS: A total of 15 women and 5 men (mean age 40.3 16.8) with GPD underwent spine surgery and were discharged the same day. Lumbosacral disc pathology was identified at multiple levels, the most common being L4-L5 and L5-S1. Patients were followed for an average of 20 months (range 12-37 months). 80% (16/20 patients) reported improvement on the PGI-I. There were no serious surgical complications. CONCLUSIONS: When assessing GPD the urologist should look beyond the genito-pelvic region. GPD can be a result of sacral radiculopathy from lumbosacral disc disease. Long-term alleviation of GPD symptoms is achievable with spine surgery. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e330 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Irwin Goldstein More articles by this author Choll Kim More articles by this author Sue Goldstein More articles by this author Maria Uloko More articles by this author Noel Kim More articles by this author Barry Komisaruk More articles by this author Expand All Advertisement PDF DownloadLoading ...