Role of Pudendal Canal Syndrome in the Pathogenesis of Interstitial Cystitis and Its Treatment by Pudendal Canal Decompression

Abstract

Objective: Pudendal canal syndrome (PCS) which is comprised of pudendal nerve compression in the pudendal canal occurs commonly in females and presents with pelvic, pubic, suprapubic, anal, and perianal pain, as well as dysuria and dyspareunia. These manifestations are similar to those of interstitial cystitis (IC). We investigated the hypothesis that IC is a manifestation of PCS and may thus respond favorably to similar treatment. Patients and Methods: Sixty-six patients (59 women, age 41.6 ± 4.2 years) complained of suprapubic, pubic, perineal, anal, and vaginal pain, dyspareunia, dysuria, and urinary frequency. Neurologic examination showed perianal and perivulvar hypoesthesia and an absent anal reflex. There were subnormal anal pressure and diminished electromyography of the external urethral sphincter and puborectalis and levator ani muscles as well as an increase of pudendal nerve terminal motor latency. These results pointed to the manifestations being possibly due to pudendal neuropathy. A pudendal nerve block improved the symptoms and pudendal nerve decompression was performed. Results: In 54/66 patients, pain disappeared with improvement of anal pressure, electromyography of external urethral sphincter, puborectalis and levator ani muscles and nerve terminal motor latency. Perianal and perivulvular hypoesthesia was normalized. Twelve patients did not improve either clinically or in terms of investigative results. Conclusion: A simple, easy, and cost effective technique is presented for the treatment of IC. It was based on the symptomatic and investigative similarities between IC and PCS. Pudendal canal decompression affected a cure of IC in most of the patients. Further studies are required to reproduce these results.