Pudendal Block Research Articles

Treatment of pelvic nerve dysfunction with a short course of pudendal nerve blocks and nsaids: a 4-year quality assurance review

Chronic pelvic pain (CPP) affects approximately 15% of women and is often difficult to treat.1 Most women with CPP have symptoms suggestive of multi-organ system involvement including gynecologic, gastrointestinal, urologic, and musculoskeletal causes with or without central nervous system sensitization. Musculoskeletal origin pelvic pain has been reported to be associated with 22% of women with CPP.2 It is described by many names, but a common finding is abnormal sensitivity of tissues in the distribution of the pudendal nerve.

Vestibulectomy for provoked vulvodynia: not just a last resort

This video highlights anatomical landmarks when performing a vestibulectomy and outlines tools and techniques for optimal tissue resection and clinical success. Provoked vulvodynia is a chronic vulvar pain condition lasting 3 months or more without any other identifiable cause affecting approximately 16% of women in the general population. It is characterized by burning, stinging, irritation, sharp stabbing pain, or pressure that occurs as a result of physical contact. Treatment of this condition is challenging, and surgical excision is often reserved for refractory cases. The vestibule is embryologically unique and arises from the endoderm of the cloacal membrane that breaks down as the urogenital sinus opens between the genital folds forming the vestibule. This tissue is also unique histologically being densely populated with site-specific fibroblasts that have an enhanced pro-inflammatory response, likely contributing to pain thresholds. Hart’s line represents the change of external vulvar skin and demarcates the vestibular edge from the labia minora. The boundaries of resection should include Hart’s line laterally, the hymenal ring medially, and include the fossa navicularis extending to the posterior forchette. The epithelium overlying the greater and lesser vestibular glands, also known as the Bartholin’s and Skene’s glands, should be included. Dissection of the vaginal epithelium should include Colle’s fascia, approximately 3mm in depth. Needlepoint cautery is helpful for precise excision and hemostasis. Pleating stitches are used for reapproximation of the underlying tissue, hemostasis, and to reduce tension on the epithelial closure. Intraoperative pudendal blocks can be performed for pain control. Vestibulectomy for provoked vulvodynia is an effective treatment and should be considered earlier in the treatment algorithm. This video demonstrates preferred techniques for a successful procedure.

Choice of local anesthetic in obstetric anesthesiology: literature review and demonstration of our own experience

Regional anesthesia is widely used in obstetric practice, and in many cases is the method of choice. It in­cludes neuroaxial anesthesia (spinal, epidural, combined spinal­epidural, epidural with dura mater puncture), region­al blocks (eg, TAP block, QL block, ESP block, pudendal block, etc.), as well as local infiltration anesthesia, which is used for both anesthesia and postoperative analgesia. The correct choice of local anesthetic, its dose and concentration is of fundamental importance in obstetric anesthesiology, as it is necessary to ensure the highest quality blockade with mini­mal side effects on mother and fetus.

Ultrasound-Guided Pudendal Nerve Block versus Ultrasound-Guided Dorsal Penile Nerve Block for Pediatric Distal Hypospadias Surgery

Introduction: The primary aim of the study was to use the duration until the first postoperative analgesic requirement after two different block techniques to compare the analgesic effect. The secondary aims were to compare the two methods for postoperative Children’s Hospital Eastern Ontario Pain Scale (CHEOPS) scores, complications, and parental satisfaction level. Materials and Methods: This prospective, observational study was conducted with male patients aged 1–7 years in the ASA I–II group, who were scheduled for hypospadias surgery between November 2019 and April 2020. Ultrasound (US)-guided pudendal nerve block (PNB) or US-guided dorsal penile nerve block (DPNB) was administered under general anesthesia before the operation. Postoperative analgesic need, postoperative pain, complications, and parental satisfaction were noted. The STROBE checklist was followed for reporting. Results: The study was conducted with 30 patients in total, divided into 15 patients receiving PNB and 15 patients receiving DPNB. The effective minimum block duration was longer in the pudendal group at 22.22 ± 0.61 h than in the DPNB group at 22.19 ± 0.57 h. Additional analgesic was required in 4 subjects in the pudendal group and 5 in the DPNB group. There was no statistically significant difference in terms of the variables between the two groups (p > 0.05). Discussion: US-guided DPNB and PNB were shown to provide successful postoperative analgesia and to have similar effectiveness in pediatric patients undergoing hypospadias surgery in this first prospective study of its kind in the literature. Conclusions: US-guided DPNB and PNB have been demonstrated to provide effective, safe, and long-term postoperative analgesia in pediatric patients who have undergone hypospadias surgery. Parental satisfaction in both groups is positively influenced by the minimum postoperative analgesia requirement, the long-term analgesic effect, and the lack of any complications.

Report from 'ESCP 2021 Virtual': the 16th Scientific and Annual Conference of the European Society of Coloproctology, 22-24 September 2021.

Report from 'ESCP 2021 Virtual': the 16th Scientific and Annual Conference of the European Society of Coloproctology, 22-24 September 2021.

An assessment of photodynamic therapy efficacy for the treatment of Bowen’s disease of the vulva

Vulvar cancer occupied the 4th place (3–8 %) in the distribution of the malignant neoplasms of female genital organs, although this disease is considered to be rare. In the United States, about 4,000 new cases of vulvar cancer are diagnosed every year, and 850 women die from this cancer. An estimated 650 new cases of this disease are reported per year in Ukraine. One of the precancerous lesions of the vulva along with Paget’s disease is Bowen’s disease, which can progress to squamous cell carcinoma. Photodynamic therapy (PDT) is regarded as an effective method of this disease treatment in the vulva area. The aim of this study was to assess the efficacy and tolerability of PDT in women with Bowen’s disease of the vulva (BDV). Materials and methods. A retrospective study of patients with high-grade Bowen’s disease of the vulva, who were treated with a fundamentally new method of PDT using a systemic photosensitizer photolon, was carried out. During and after PDT, perioperative anesthesia and reduction of the inflammatory process were performed for patients with the help of analgesics, local anesthetics and peripheral blockade of the pudendal nerve (pudendal nerve block). Results. 23 women with a mean age of 38.1 years (range 30–54 years) were included in the study. Based on a number of histological and cytological methods, biopsy and vulvoscopy, the diagnosis of BDV was established, which is currently classified as high-grade squamous intraepithelial lesion of the vulva. Treatment was performed with PDT. The complete response rate of BDV patients with area percentage of the vulvar mucosa lesions of 25 %, 50 % and 100 % was 73.8 % following irradiation after the 1st, 2nd and 3rd series of PDT for 3 months to 1–2 years of follow-up. A partial response was achieved in 13.1 %, while no effect was also reported in 13.1 % of patients. In addition, some patients experienced pain of moderate to severe intensity. Conclusions. Despite the small sample of BDV patients, PDT using both photolon as photosensitizer and an optimized photoirradiation regimen is a potential therapeutic organ-sparing treatment option for patients with high-grade squamous intraepithelial lesions of the vulva. However, there is still a need to study the PDT procedure and the anesthesia choice in combination with various analgesics for patients with a high area percentage of vulvar lesions.

Ischiorectal Abscess Under Bilateral Pudendal Nerve Block for Perioperative Analgesia in a Patient with Severe Ischaemic Heart Disease- A Case Report

Anorectal abscess, an infection in the anal area is a potentially debilitating and painful condition requiring urgent drainage to prevent septicemia. Commonly performed under neuraxial anaesthesia, we report surgical drainage of bilateral ischiorectal abscess under bilateral pudendal nerve blocks and general anaesthesia in a patient with severe ischaemic heart disease. Through our case we add to the existing literature, the importance of administrating peripheral nerve block in highly co-morbid patients. Keywords: Anorectal abscess, Bilateral pudendal block, Severe ischaemic heart disease.

Regional methods of anesthesia in labor pain relief: a systematic review

INTRODUCTION: Today epidural anesthesia is the “golden standard” of anesthesia. But what can we do if the application of an epidural catheter is contraindicated? The use of narcotic analgesics can hardly be deemed a worthy alternative. OBJECTIVE: To identify alternative regional methods of anesthesia in labour pain relief. MATERIALS AND METHODS: We have performed a systematic review of literature in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guideline principles. The bibliographic search was conducted in January-March 2022. The search was performed in the MEDLINE, EMBASE, eLibrary.ru, Cochrane Library databases. The search keywords were: anesthesia of childbirth, pudendal block, paracervical block, paravertebral block, quadratic lumbar muscle (QLB) block, erector spinae plane block (ESPB). We found 122 works, and after removing 94 works for various reasons, 28 works were analyzed. RESULTS: We found 122 works, and after removing 94 works for various reasons, 28 works were analyzed. We identified six randomized controlled trials related to the subject matter, but the endpoints were heterogeneous preventing a statistical analysis; therefore, we performed a qualitative review of the literature. Works dedicated to paravertebral and paracervial blocks showed sufficient effectiveness of anesthesia for the second period of labor. Good results of anesthesia of the second period of labor were also described with the use of ESPB and bilateral QLB. Nevertheless, it is impossible to draw statistically significant conclusions on the use of ESPB and QLB due to the small sample. Articles devoted to the use of pudendal block in labour revealed its low effectiveness. CONCLUSIONS: The described results show that paravertebral, ESPB and QLB blocks can be used as alternative regional methods of anesthesia in labour. However, further research is required to assess the effectiveness of their use in childbirth.

Clinical Observation of Bilateral Pudendal Nerve Block Anesthesia Combined with Unprotected Perineal Delivery

Clinical Observation of Bilateral Pudendal Nerve Block Anesthesia Combined with Unprotected Perineal Delivery

Sixty-Day Pudendal Nerve Stimulation: A Potential Therapy for Refractory Pudendal Neuralgia Case Report

BACKGROUND: Pudendal neuralgia (PN) can cause severe, disabling chronic pain. Though common, PN is frequently unrecognized and misdiagnosed. Historically, the last-resort treatment for PN has been permanent implantation of spinal cord stimulation (SCS), but SCS for PN carries high risk of complications and explantation. We report the first case of temporary (60-day) peripheral nerve stimulation (PNS) treatment for refractory PN. CASE REPORT: A 63-year-old woman presented with one year of chronic bilateral suprapubic vaginal pain radiating to the bilateral proximal medial thighs with concomitant dysuria, urinary frequency, and pain with intercourse. PN was confirmed via diagnostic pudendal nerve block. Using fluoroscopic guidance, we implanted PNS leads on the left and, subsequently, the right pudendal nerves, with explantation at 60 days for each lead. The patient reported continuing pain reduction with 80% improvement in the Visual Analog Scale score at 6 months, resumption of normal activity and functionality, discontinued use of opioids, and high satisfaction with treatment. This case is notable for the sustained pain relief provided by this temporary and minimally invasive treatment. CONCLUSIONS: This case suggests that 60-day PNS with fluoroscopic guidance is a viable treatment for refractory PN in correctly selected patients. This treatment is low-risk, minimally invasive, and may be used early in the care continuum, potentially sparing patients multiple failed treatments and the risks associated with permanently implanted devices. KEY WORDS: Pudendal nerve, peripheral nerve stimulation, neuromodulation, chronic pain, pelvic pain, perineal pain, case report

Surgeon-administered ilio-inguinal and pudendal nerve blocks for major vulval surgery: An observational study with visual analogue pain scoring

Surgical excision of the groin and vulva is a painful procedure. Traditionally following general or regional anaesthesia, local anaesthetic was infiltrated around the wound. Thedistribution varied and the somatic pain control was not reliable. Inspired by the success of the application of peripheral nerve blocks for postoperative pain control with open abdominal procedures, we introduced blockade of the ilioinguinal nerve (IIN) and pudendal nerve (PN) into our vulval surgery to assess the requirement for parenteral and oral analgesia in the postoperative period.This is an observational study of all patients undergoing major vulval and/or related groin surgery. Sampling biopsies were excluded. Levobipuvicaine 0.25% (2.5 mg/ml) or 0.5% (5 mg/ml) was used for and dosage was calculated based on the patient’s weight with no more than 2 mg/kg. For example, using 0.25% of levobupivacaine (2.5 mg/ml) for a 70 kg patient, 56 ml is administered divided into 4, giving 14mls at each site (2 sites abdominally for IIN block and 2 sites for pudendal block).Eighteen women were included in the analysis. Median age was 67 (range 34–81) years and thirteen (72%) were >60 years. Visual analogue scores (VAS) ranged from 0 to 3 for seventeen patients from day 0 to day 1 and fifteen patients from day 2 to day 5. Two patients had pain scores >4 on one or more postoperative days: one had chronic arthralgia and one had received a lower volume of bupivacaine.This observational study demonstrates that ilioinguinal and pudendal nerve LA blocks may be a valuable addition to the multimodal postoperative analgesic pathway for women undergoing major surgical excision in the vulva and groin.

Pudendal nerve block prior to inflatable penile prosthesis implantation: decreased intra-operative narcotic requirements.

The opioid epidemic has proven to be a public health crisis over the past two decades and efforts to decrease opioid exposure are sorely needed. Our objective was to determine whether pudendal nerve block utilization in the immediate pre-operative setting decreases intra-operative opioid analgesic requirements in veteran patients undergoing a primary inflatable penile prosthesis implantation. We performed a retrospective cohort analysis of all patients undergoing penile prosthesis implantation between January 2017 and July 2020 at the Charlie Norwood Veterans Affairs Medical Center in Augusta, GA. Univariable and multivariable gamma regression analyses were performed to evaluate the association between pudendal nerve block utilization and intra-operative opioid analgesic requirements. The study cohort consisted of 110 patients, 35 (31.8%) of whom underwent a pudendal nerve block. Median intra-operative opioid analgesic requirements were significantly lower in the pudendal nerve block group (16.3 versus 25.8 morphine milliequivalents, p = 0.037). Receipt of the nerve block was associated with significantly lower intra-operative opioid analgesic requirements on multivariable (coefficient 0.84, p = 0.038) regression analysis. There was no significant difference in post-operative opioid analgesic requirements (p = 0.18). In conclusion, pre-operative pudendal nerve blocks decrease intra-operative opioid analgesic requirements in veteran patients undergoing a primary inflatable penile prosthesis implantation.

Ultrasound Image-Guided Pudendal Nerve Block on Analgesic Effect of Perineotomy under Optimized Fast Super Resolution Reconstructed Convolutional Neural Network Algorithm

This work was aimed to study the analgesic effect of pudendal nerve block on obstetrics and gynecology under the guidance of ultrasound image based on optimized fast super resolution reconstructed convolutional neural network (FSRCNN) algorithm. A total of 110 primiparas from hospital who gave birth through vagina were randomly rolled into experimental group (55 cases) and control group (55 cases). The optimized FSRCNN algorithm was constructed, compared with the FSRCNN algorithm and the Bicubic algorithm and applied to 110 cases of maternal patients undergoing perineotomy under ultrasound image-guided pudendal nerve block. Visual analogue scoring (VAS), incision suture pain VAS score, occurrence of complications, puerpera labor time, and newborn weight were recorded and compared, so did Apgar score of newborns, numbness of maternal thigh, recovery of puncture site, and satisfaction of maternal analgesia. The results showed that the peak signal-to-noise ratio (PSNR) of the high-resolution image reconstructed by the FSRCNN algorithm was 32.68 dB and that reconstructed by the optimized FSRCNN algorithm was 32.19 dB. The PSNR of the Bicubic algorithm processed image was 28.51 dB. In the lateral resection of episiotomy in the second stage of labor, the visual analog score (2.3 ± 1.5 points) of the experimental group was inferior to that of the control group (7.1 ± 2.6 points) ( P < 0.05 ). The visual analogue score of stitch pain (1.3 ± 0.8 points) was also inferior to that of the control group (5.2 ± 1.9 points) ( P < 0.05 ). Moreover, the satisfaction of the parturients in the experimental group (9.86 ± 0.41 points) was considerably superior to that of the control group (7.36 ± 1.25 points) ( P < 0.05 ). In short, the optimized FSRCNN algorithm had a short training time and good reconstruction effect. Ultrasound-guided pudendal nerve block had a substantial analgesic effect on the second stage of labor and improved parturients’ satisfaction.

Pudendal Nerve Blocks: An Introduction and How-to Guide

<h3>Study Objective</h3> To provide a stepwise description of the anatomy, evidence, and technique for performing pudendal nerve blocks for the treatment of pudendal neuralgia. <h3>Design</h3> Video demonstration with narrated description. <h3>Setting</h3> Academic tertiary care site. <h3>Patients or Participants</h3> Patients with pudendal neuralgia. <h3>Interventions</h3> Digital transvaginal pudendal nerve blocks and blocks of the terminal peripheral branches of the pudendal nerve, including the perineal and dorsal clitoral branches. <h3>Measurements and Main Results</h3> Pudendal neuralgia can be identified using the Nantes criteria, which includes pain in the distribution of the pudendal nerve, increased pain with sitting, not being awakened by pain, lack of sensory loss, and resolution of pain after pudendal nerve block. Pudendal nerve blocks have been shown to provide relief in over 75% of patients with pudendal neuralgia, with relief potentially lasting from days to months post-procedurally. This video presents both a transvaginal digital approach to pudendal nerve block as well as targeted blocks of the peripheral branches of the pudendal nerve, including the perineal and dorsal clitoral branches. A review of the relevant clinical anatomy, benefits and risks of the procedures, type and toxicity of injectate medications, procedural set up, procedural techniques, and post-procedural follow up care is presented. <h3>Conclusion</h3> Pudendal nerve blocks, when performed through a safe and standardized approach, are a beneficial therapeutic tool for clinicians caring for patients with pudendal neuralgia.

Labia Majora Lift. for Whom? When? How? What Is Next?

<h3>Study Objective</h3> The study aims to present our technique of wedge excision(lifting) labia majora,how the first important step in the sequence of rejuvenating procedures in this area. <h3>Design</h3> prospective cohort study since July 2018. <h3>Setting</h3> A wedge excision technique (fotos and video step by step). <h3>Patients or Participants</h3> The total number of the procedures was 127, including: 78 (65%) combined procedures with labia minora reduction; 51 (40%) combined procedures with skin lightening. A wedge excision technique with subsequent suturing was used (photos and video will be demonstrated) under intravenous or pudendal anesthesia. <h3>Interventions</h3> the aesthetic treatment of labia majora is as relevant and demanded as labia minora enhancement. Our patients notice tissue sagging, laxity, wrinkling and hyperpigmentation in this area and seek its improvement. These goals can be achieved in a number of ways, the most common of which are lipoplasty, treatments with HA fillers and laser-assisted rejuvenation. We believe that surgical treatment of labia majora is of great interest, and it opens opportunities for obtaining predictable aesthetic outcome and higher satisfaction with this procedure in general. <h3>Measurements and Main Results</h3> The mean duration of the procedure was 45 minutes. There were no serious complications. The recovery period lasted 2-3 weeks. Postoperatively, edema was observed in 32 % of cases. There were no cases of hematomas, bleeding, or purulent/septic complications. Antimycotic agents were used. During the next 1-3 months, additional correction with fillers was used in 20 cases (15%), which was indicative of high satisfaction with the procedure outcome among the majority of the patients and of proper strategy choice in each individual case. <h3>Conclusion</h3> Surgical labia majora lift is a promising technique, which gives long-lasting and, most importantly, predictable outcomes. Good aesthetic results can be obtained using this technique alone or in combination with other rejuvenating procedures. It provides high satisfaction along with low complication rates.

Effect of Pudendal Nerve Block versus Perineal Local Infiltration of Analgesia In Post Episiotomy Pain Relief A randomized Controlled Clinical Trial

Abstract Background Episiotomy or tearing of perineal tissues during childbirth is associated with significant pain in the postpartum period. Although the use of episiotomy is often debated, it remains the most common surgical procedure experienced by women. Pain from episiotomy is poorly treated, though it may be severe and can result in significant discomfort and interference with basic daily activities and adversely impact motherhood experiences. Local infiltration analgesia is the most commonly used method of analgesia during normal labor. This type of local analgesia is achieved by injecting the analgesic agent into the perineum just before delivery with crowning of the fetal head. It is also widely used just before an episiotomy. This study compares the efficacy and duration of pudendal nerve block versus local infiltration on post episiotomy pain relief. Aim of the Work: This study aims to compare the effect of Pudendal Nerve Block with perineal local infiltration of analgesia in post episiotomy pain relief. Study design:Prospectiverandomizedcontrolledclinicaltrial. Patients &amp; Methods The current study was conducted in Ain Shams University Maternity Hospital in the period between August 2018 and Jan 2019. It included 100 primigravida women in labor meeting inclusion criteria attending the causality of Ain Shams Maternity Hospital. Results Our study showed statistically significant decrease mean of study group compared to control group according VAS score from after 1hr to after 6hrs. Also there was statistically significant decrease in patients' need for analgesia in study group compared to control group from after 1hr to after 6hrs. Patients were asked about episiotomy pain and were advised not to be distracted by pain of uterine contraction or any other pain she complains of as much as possible not to alter the study results Regarding the pudendal nerve block group none of the patients receiving effective bilateral pudendal nerve block asked for analgesia during the first hour post injection. Two patients representing 4.4% of the study group asked for analgesia after two hours post injection, by the 3rd hour 6 patients representing 13.3% of the study group asked for analgesia. After completing 6 hours post injection follow up only 21 patients asked for analgesia representing 46.7% of the study group while 24 patients (53.3%) did not require any analgesia for the first 6 hours after injection of pudendal nerve block Conclusion There is statistically significant decrease in mean VAS in pudendal nerve block compared to local perineal infiltration of analgesia from after 1hr to after 6hrs of injection. Also there is statistically significant decrease in patients' need for analgesia in case of pudendal nerve block compared to local perineal infiltration of analgesia from after 1hr to after 6hrs of injection. There is highly statistically significant increase mean of delivery time after injection (min) in pudendal nerve block compared to local perineal infiltration of analgesia but it has no clinical significance. There are no neonatal side effects or complications of pudendal nerve block.

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)\u2014part VII, nerves of the lower limb

ObjectivesTo perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton’s neuroma) and provide clinical indications.MethodsWe report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around peripheral nerves in the lower limb (excluding Morton’s neuroma) to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper.ResultsNine statements on image-guided interventional procedures for peripheral nerves of the lower limb have been drafted. All of them received strong consensus. Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia.ConclusionDespite the promising results reported by published papers on image-guided interventional procedures for peripheral nerves of the lower limb, there is still a lack of evidence on the efficacy of most procedures.Key Points• Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications.• US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role.• US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. The volume of local anesthetic affects the size of the blocked sensory area.

Postoperative pain after clitoral reconstruction in women with female genital mutilation: An evaluation of practices

IntroductionMore than 200 million women and girls have undergone genital mutilation. Clitoral reconstruction (CR) can improve the quality of life of some of them, but is accompanied by significant postoperative pain. ObjectiveAssess and describe the management of postoperative pain after CR, and the practices amongst specialists in different countries. Methods: Between March and June 2020, 32 surgeons in 14 countries (Germany, Austria, Belgium, Burkina Faso, Canada, Ivory Coast, Egypt, Spain, United States of America, France, the Netherlands, Senegal, Switzerland, Sweden) responded to an online questionnaire on care and analgesic protocols for CR surgery. ResultsAt day 7 post CR, 97% of the surgeons observed pain amongst their patients, which persisted up to 1 month for half of them. 22% of the participants reported feeling powerless in the management of such pain. The analgesic treatments offered are mainly step II and anti-inflammatory drugs (61%). Screening for neuropathic pain is rare (3%), as is the use of pudendal nerve block, used by 8% of the care providers and only for a small percentage of women. ConclusionPain after CR is frequent, long-lasting, and potentially an obstacle for the women who are willing to undergo clitoral surgery and also their surgeons. Most surgeons from different countries follow analgesic protocols that do not use the full available therapeutic possibilities. Early treatment of neuropathic pain, optimisation of dosing of standard analgesics, addition of opioids, use of acupuncture, and routine intraoperative use of pudendal nerve block might improve the management of pain after CR.

Botulinum toxin injection is an effective alternative for the treatment of chronic anal fissure

Objectives There are few published data on the optimized use of botulinum toxin A (BTA) for the treatment of chronic anal fissure (CAF). The aim of this study was to investigate the effect of injection of 100 IU BTA into the internal anal sphincter (IAS) at the side opposite of the fissure, using an anal retractor, sedation, and perianal transcutaneous pudendal nerve block. Methods The prospectively maintained data of 132 patients who underwent BTA injection for CAF were retrospectively analyzed. Demographic data, symptom duration, fissure location, post-procedure pain, complications, continence status, response to treatment, and follow-up period were investigated. Postoperative analgesic requirements of patients who did and did not receive pudendal nerve block were compared. Results Eighty-two patients were male and the median age was 40 (18–74) years. Sixty-six patients required no, 46 required oral, and 20 required parenteral analgesics. No complications were observed. Complete response was observed in 105 patients (79.5%). Symptomatic improvement was observed in 67.4% of patients within 3–7 d. Median follow-up was 24 (18–42) months. The median Wexner’s incontinence score was 0 (0–8) at 1 month. In all, 104 patients had no, 22 patients had minor, and 6 patients had non-minor incontinence. All patients with incontinence recovered fully within 4 (2–13) weeks. Conclusions BTA injection using an anal retractor under sedation and perianal transcutaneous pudendal nerve block is an effective and safe alternative to partial lateral internal sphincterotomy (LIS) for the treatment of CAF.

PD36-12 STIMWAVE® FOR PUDENDAL NEURALGIA

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (PD36)1 Sep 2021PD36-12 STIMWAVE® FOR PUDENDAL NEURALGIA Ly Hoang Roberts, Annah Vollstedt, Josh Volin, Teresa McCartney, and Kenneth Peters Ly Hoang RobertsLy Hoang Roberts More articles by this author , Annah VollstedtAnnah Vollstedt More articles by this author , Josh VolinJosh Volin More articles by this author , Teresa McCartneyTeresa McCartney More articles by this author , and Kenneth PetersKenneth Peters More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002040.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients with pudendal neuralgia refractory to traditional therapies, prior studies have shown efficacy in chronic stimulation with Interstim® (Medtronic, Inc., Minneapolis, MN). This study reports on a wireless system to power an implanted lead at the pudendal nerve, StimWave®, to treat pudendal neuralgia. METHODS: Retrospective chart review identified patients with a lead placed at the pudendal nerve for neuralgia and powered wirelessly. Clinical outcomes were assessed at post-operative visits and phone calls. Administered non-validated follow-up questionnaire evaluated the GRA, percentage of pain improvement, satisfaction with device, and initial and current settings of the device (hours/day of stimulation). RESULTS: Thirteen patients had the StimWave® lead placed at the pudendal nerve, 12 (92%) female and 1 (7.6%) male. Mean age was 50 years (range: 20-58). Failed prior therapies include medical therapy (100%), pelvic floor physical therapy (PFPT) (92%), pudendal nerve blocks (85%), pelvic floor muscle trigger point injections (69%), neuromodulation (30.7%), or surgeries for urogenital pain (23.1%). After the trial period, 10/13 (76.9%) had >50% improvement in pain with 6/13 (46.1%) reporting 100% pain improvement. Nine underwent permanent lead placement. At last post-operative visit (range 6-83 d), 4/9 patients reported >50% pain improvement. Seven patients reached for phone calls (8-734 d) reported symptoms to be "markedly improved" (n=2; 28.6%), "moderately improved" (n =4; 57.1%,), or "slightly improved" (n=1; 14.3%). Over half (5/7) reported complications including lead migration (n=2), broken wire (n=1) or non-functioning antenna (n=2). CONCLUSIONS: Complex patients with refractory pudendal neuralgia may benefit from pudendal nerve stimulation via StimWave. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e600-e600 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ly Hoang Roberts More articles by this author Annah Vollstedt More articles by this author Josh Volin More articles by this author Teresa McCartney More articles by this author Kenneth Peters More articles by this author Expand All Advertisement Loading ...