Surgical Decompression of Pudendal Nerve by Transperineal Approach Using a Balloon Probe

Eric De Bisschop,Rajeshree Nundlall

doi:10.5923/j.ajmms.20120204.05

Abstract

Since 2009 may to 31 january 2012, 512 patients (371 females, 141 males) have benefited from a pudendal nerve (PN) decompression by transperineal approach using a ballon probe. These patients had clinical symptoms of pudendal neuralgia. Neurophysiological tests based on the staged sacral reflexes, on ultrasound investigations of pudendal vessels and on a pelvic floor ultrasounds evoked a zone of compressive hyperpressure at the level of the axis infrapiriformis area-ischiorectal fossa. All of these 512 patients, injection block at the level of the infrapiriformis area appeared positive between 1 to 9 months. Patients were known for this pathology since many years. Among these 512 patients, 66 had already PN decompression, 27 by transgluteal approach, 36 by transvaginal (â)/transischiorectal (â) approach and 3 by transperineal approach (Shakik extended) but without clinical efficiency.All of these 512 patients, surgical decompression was done by transperineal approach using a balloon probe.Surgical methodology, post-op follow up and results are reported hereby, which appear quite successful with few risks to make worse the pathology and no risk on pelvic static.

Highlights

Pudendal neuralgia is pain and/or functional signs in one or more of the territories of the PN.The pudendal nerve can undergo many lesional phenomena throughout his pathway, intra-or extra-spinal.The 512 patients selected had a conflict at the level of the infra-piriformis-ischiorectal fossa axis
Electroneuromyographic investigation correlated with pelvic-perineal ultrasound is more reminiscent of a phenomenon of a tissue hyperpressure than a canal syndrome
Electroneuromyographic investigations based on the staged sacral reflexes[4] and on pelvic floor ultrasounds[5,6] evoked a compressive hyperpressure at the level of the infrapiriformis area-ischiorectal fossa axis

Summary

Introduction

Pudendal neuralgia is pain and/or functional signs in one or more of the territories of the PN.The pudendal nerve can undergo many lesional phenomena throughout his pathway, intra-or extra-spinal (fig. 1).The 512 patients selected had a conflict at the level of the infra-piriformis-ischiorectal fossa axis. Pudendal neuralgia is pain and/or functional signs in one or more of the territories of the PN. The pudendal nerve can undergo many lesional phenomena throughout his pathway, intra-or extra-spinal The 512 patients selected had a conflict at the level of the infra-piriformis-ischiorectal fossa axis. Conflicts at the piriformis muscle and / or nerve root L4, L5 and S1 were discarded. Electroneuromyographic investigation correlated with pelvic-perineal ultrasound (tissue structure) is more reminiscent of a phenomenon of a tissue hyperpressure than a canal syndrome.

Methods

Results

Conclusion