Pudendal canal decompression in the treatment of urinary stress incontinence

Abstract

Twelve women with urinary stress incontinence (USI) due to pudendal canal syndrome (PCS) were treated by pudendal canal decompression. The investigations comprised determination of the EMG activity of the external urethral sphincter (EUS) as well as the straining urethral reflex latency and pudendal nerve terminal motor latency (PNTML). The EMG of the EUS revealed diminished activity at rest and with coughing, with prolonged straining urethral reflex latency and PNTML. There was diminished sensation in the labia majora. These manifestations point to PCS and so pudendal canal decompression was performed. This comprised exposure of the inferior rectal nerve in the ischiorectal fossa through a para-anal incision. The nerve was traced to the pudendal nerve in the pudendal canal, which was split open. The patients were followed for a mean of 17.7 months ±4.2 SD. Three scores were defined: 1, where the patient became dry (6 patients); 2, where the patient unproved (5 patients); and 3, where no change was noted (1 patient). In scores 1 and 2 there was improvement in labia majora sensation and EMG activity of the EUS, as well as a decrease in the straining urethral reflex latency and the PNTML. The technique corrects a basic cause of USI, in contrast to other procedures which deal instead with the effects. The technique is simple, easy and without complications and can be done on an outpatient basis.