PD54-12 CURING PATIENTS WITH NEUROGENIC SEXUAL DYSFUNCTION THROUGH A NOVEL COLLABORATIVE PROTOCOL INCORPORATING MINIMALLY-INVASIVE SPINAL SURGERY: LARGEST KNOWN RETROSPECTIVE SERIES

Abstract

You have accessJournal of UrologySexual Function/Dysfunction: Female1 Apr 2018PD54-12 CURING PATIENTS WITH NEUROGENIC SEXUAL DYSFUNCTION THROUGH A NOVEL COLLABORATIVE PROTOCOL INCORPORATING MINIMALLY-INVASIVE SPINAL SURGERY: LARGEST KNOWN RETROSPECTIVE SERIES Eric Biewenga, Sue Goldstein, Vera Trofimenko, Barry Komisaruk, Jennifer Hanley, Choll Kim, and Irwin Goldstein Eric BiewengaEric Biewenga More articles by this author , Sue GoldsteinSue Goldstein More articles by this author , Vera TrofimenkoVera Trofimenko More articles by this author , Barry KomisarukBarry Komisaruk More articles by this author , Jennifer HanleyJennifer Hanley More articles by this author , Choll KimCholl Kim More articles by this author , and Irwin GoldsteinIrwin Goldstein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2620AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Persistent genital arousal disorder (PGAD) was first described in 2001. From 2001 - 2012, the pathophysiology was elusive, treatment was focused primarily on symptom-reduction, and cures of PGAD were rare. In 2012 Komisaruk was the first to describe PGAD secondary to radiculitis of a sacral spinal nerve root (SSNR) from Tarlov cysts. It was subsequently hypothesized that other lumbar spine cauda equina-based pathologies, including annular tears, disc impingements, spinal stenosis, or Facet cysts, could result in radiculitis of a SSNR causing PGAD. METHODS Women presenting with PGAD underwent diagnostic neuro-genital testing including quantitative sensory testing, sacral dermatome testing and bulbocavernosus reflex latency testing. If abnormal, then lumbar/sacral MRI studies assessed for a treatable spine abnormality (TSA). If a TSA was found a targeted transforaminal epidural spinal injection (TFESI) was performed to ascertain robust PGAD symptom reduction. In appropriate patients, minimally-invasive spine surgery was performed. RESULTS Over the past 30 months, 27 women presented with PGAD. Ten women (mean age 44 years, range 18-67) have met pre-operative inclusion criteria based on a multi-dimensional management paradigm and have undergone minimally-invasive surgery. Eight women had >2 month follow-up and are included here. Pathophysiologies included annular tear (n=5), spondylolisthesis (n=1), facet cyst (n=1), and spinal stenosis (n=1). Seven patients underwent minimally-invasive laser endoscopic spine surgery and one underwent minimally-invasive spinal reconstruction and fusion. Of the eight patients who underwent surgery, five had a Patient Global Impression of Improvement score of 1 (very much better), one scored a 3 (a little better) and two scored a 4 (no change in symptoms). Quality of life regarding sexual function has already been achieved in 63%, although follow up has been less than half a year in many of the cases. There were no surgical complications. This same protocol has been used to treat other sexual dysfunctions with similar results. CONCLUSIONS This is the first study, to our knowledge, showing successful surgical treatment of PGAD related to various cauda equina based lumbar pathologies causing radiculitis of a SSNR. A multi-dimensional management paradigm has been developed to help women with PGAD to be cured by minimally-invasive spinal surgery. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1055 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Eric Biewenga More articles by this author Sue Goldstein More articles by this author Vera Trofimenko More articles by this author Barry Komisaruk More articles by this author Jennifer Hanley More articles by this author Choll Kim More articles by this author Irwin Goldstein More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...