Pudendal Nerve Entrapment Syndrome Research Articles

Ossification of Bilateral Sacrotuberous Ligaments: Two Cases Report and Literature Review.

Ossification of the sacrotuberous ligament is a rare occurrence in soft tissue, with only 15 cases reported in the past few decades. We reported two cases of bilateral ossification in sacrotuberous ligaments and provided a concise review of the literature on this pathology. Clinical data, radiographic outcomes, and diagnostic and treatment details were obtained. This study aimed to summarize this disease's characteristics and investigate its pathogenesis through a review of literature from the last thirty years. This condition is often incidentally confirmed in elderly males via imagiological examination or gross anatomy and presents a low morbidity rate. Its pathogenesis may be related to stress concentration, excessive intake of element ions, injury repair, and improper operative technique. The majority of patients may not exhibit any clinical symptoms or signs and typically do not require medical interventions. It may be complicated with pudendal nerve entrapment syndrome. The long-term effects of surgical resection and the most effective treatment approach remain areas for further research.

Pudendal Neuralgia: Two case reports with laparoscopic nerve decompression.

Pudendal neuralgia (PN) is a rare and underestimated condition. The reported incidence by the International Pudendal Neuropathy Association is 1/100000. However, the actual rate may be significantly higher, with a propensity for women. It is most frequently caused by an entrapment of the nerve at the level of the sacrospinous and sacrotuberous ligament, also known as pudendal nerve entrapment syndrome. Due to the late diagnosis and inadequate management, pudendal nerve entrapment syndrome often leads to considerable reduction in the quality of life and high health care costs. The diagnosis is made using Nantes Criteria, in conjunction with the patient's clinical history and physical findings. Clinical examination with an accurate assessment of the territory of the neuropathic pain is mandatory to set the therapeutic strategy. The aim of the treatment is to control the symptoms and it usually starts with conservative approaches which include analgesics, anticonvulsants, and muscle relaxants. Surgical nerve decompression can be proposed after failure of conservative management. The laparoscopic approach is a feasible and appropriate technique to explore and decompress the pudendal nerve, and to rule out other pelvic conditions that can cause similar symptomatology. In this paper, the clinical history of two patients affected by compressive PN is reported. Both patients underwent laparoscopic pudendal neurolysis suggesting that the treatment for PN should be individualised and carried out by a multidisciplinary team. When conservative treatment fails, laparoscopic nerve exploration and decompression is an adequate option to propose and should be performed by a trained surgeon.

Recommendations on the management of pudendal nerve entrapment syndrome: A formalised expert consensus.

Since the development and publication of diagnostic criteria for pudendal nerve entrapment (PNE) syndrome in 2008, no comprehensive work has been published on the clinical knowledge in the management of this condition. The aim of this work was to develop recommendations on the diagnosis and the management of PNE. The methodology of this study was based on French High Authority for Health Method for the development of good practice and the literature review was based on the PRISMA method. The selected articles have all been evaluated according to the American Society of Interventional Pain Physicians assessment grid. The results of the literature review and expert consensus are incorporated into 10 sections to describe diagnosis and management of PNE: (1) diagnosis of PNE, (2) patients advice and precautions, (3) drugs treatments, (4) physiotherapy, (5) transcutaneous electrostimulations (TENS), (6) psychotherapy, (7) injections, (8) surgery, (9) pulsed radiofrequency, and (10) Neuromodulation. The following major points should be noted: (i) the relevance of 4+1 Nantes criteria for diagnosis; (ii) the preference for initial monotherapy with tri-tetracyclics or gabapentinoids; (iii) the lack of effect of opiates, (iv) the likely relevance (pending more controlled studies) of physiotherapy, TENS and cognitive behavioural therapy; (v) the incertitudes (lack of data) regarding corticoid injections, (vi) surgery is a long term effective treatment and (vii) radiofrequency needs a longer follow-up to be currently proposed in this indication. These recommendations should allow rational and homogeneous management of patients suffering from PNE. They should also allow to shorten the delays of management by directing the primary care. Pudendal nerve entrapment (PNE) has only been known for about 20years and its management is heterogeneous from one practitioner to another. This work offers a synthesis of the literature and international experts' opinions on the diagnosis and management of PNE.

364 The Cycling Urologist: Effect on PSA, Haematuria, Pudendal Nerve Entrapment and Cyclists Nodules

Abstract Aim Cycle use has vastly increased over the last few years in the UK. The aim of this review was to evaluate the effect of cycling on the common conditions presenting to the urology clinic, in particular those of raised PSA, haematuria, soft tissue lesions (“cyclist nodules”) and pudendal nerve entrapment syndromes. Method A PUBMED search of the literature on cycling and genitourinary disorders was performed. The keywords included “Bicycling” AND “Prostate-specific antigen”, “Bicycling” AND “Haematuria”, “Bicycling” AND “Cyclist Nodules”, “Bicycling” AND “Pudendal Nerve Entrapment”. Results The literature suggests no significant change in total PSA levels after a bout of cycling, regardless of age. The type of cycling (mountain biking vs. road cycling) does not influence PSA levels. It is possible that the saddle used in cycling may displace the pressure across the perineal and gluteal region to effectively alleviate pressure on the prostate. Haematuria appears to be rare with cycling but has been described. Perineal nodular induration is a very rare - although possibly under diagnosed condition. It is thought to be caused by repetitive micro trauma from contact between the perineum and saddle. Pudendal nerve entrapment (PNE) represents the most common bicycling associated urogenital problem. Numbness in the perineum, penis, scrotum or the buttocks is the most common and most recognised symptom. Genital numbness may occur unrelated to erectile dysfunction (ED) although cycling related ED is invariably associated with genital numbness. Conclusions Urology Trainees and Consultants should be aware of how recreational and high-level cycling may result in presentation to the Urology clinic.

Pudendal nerve release for lower urinary tract symptoms in young males.

The aim of this study was to assess the efficacy of laparoscopic transperitoneal pudendal decompression in the improvement of refractory lower urinary tract symptoms (LUTS) in young males presenting with clinical features of pudendal nerve entrapment with no known comorbidities that could explain their LUTS. This is a prospective pilot study involving patients suffering from LUTS refractory to standard treatment and clinical features of pudendal nerve entrapment on physical examination. They underwent laparoscopic transperitoneal pudendal decompression. International Prostate Symptom Score (IPSS) and maximal flow (Qmax) on uroflowmetry were evaluated before and 3 months after the procedure. Five male patients aged 34 ± 4 years were recruited. The median IPSS differed significantly before and 3 months after the procedure (18 vs 8, P = .042); likewise, median Qmax differed significantly before and 3 months after the procedure (12 vs 18 mL/s, P = .042). Pudendal nerve entrapment syndrome should be considered as a main differential diagnosis for refractory LUTS in young males with no other comorbidities. When clinical features of pudendal nerve entrapment are present, laparoscopic transperitoneal pudendal decompression relieves LUTS in these young males.

Urological issues in cyclists

Cycle use has grown rapidly over the last few years in the UK. British Cycling membership has increased threefold since the 2012 Olympic and Paralympic Games, and this is likely to rise in the wake of the Coronavirus pandemic. As urologists, day-to-day encounters with cyclists are commonplace, who may present with acute traumatic injuries or chronic overuse injuries. The aim of this literature review was to evaluate the effect of cycling on conditions presenting to the urology clinic, in particular those of raised prostate-specific antigen (PSA), haematuria and soft-tissue lesions (‘cyclist nodules’). Furthermore, the review aimed to summarize the relationship between cycling and pudendal nerve entrapment (PNE) syndromes. A PubMed search of the literature on cycling and genitourinary disorders was performed. The literature suggests no significant change in PSA levels after a bout of cycling. Age appears to have no effect on the change in PSA experienced following a bout of cycling, in particular when comparing those <50 years of age to those >50 years of age. Haematuria appears to be rare with cycling but has been described, even with stationary bike riding. It is imperative to exclude coexisting urinary-tract pathological conditions, and cycling-induced haematuria should always be considered a diagnosis of exclusion. Perineal nodular induration (‘cyclist nodules’) is a rare condition, related to pressure and repetitive micro-trauma between the perineum and saddle. Pudendal Nerve Entrapment (PNE) represents the most common bicycling-associated urogenital complaint. Numbness in the perineum, penis, scrotum or buttocks—‘genital numbness’—is the most common and most recognized symptom of pudendal compression. Despite several studies demonstrating a link between elite cyclists and erectile dysfunction, for the average cyclist riding may actually have a protective effect on sexual function.

Laparoscopic transperitoneal pudendal nerve and artery release for pudendal entrapment syndrome.

Pudendal nerve and artery entrapment is an underdiagnosed pathology responsible of several urinary, sexual and anorectal complaints. The aim of our study was to evaluate safety and feasibility of laparoscopic transperitoneal pudendal nerve and artery release in a large retrospective cohort of patients with pudendal nerve entrapment syndrome with both a short and long-term follow-up. Technical details and outcomes are also reported. A series of 235 patients with pudendal syndrome underwent laparoscopic transperitoneal pudendal canal release between June 2015 and February 2020. Operative data were recorded prospectively for all patients. A complete history, pain visual analog scale (VAS) for perineodynia, and three scores evaluating the main symptoms (USP, IIEF-5, PAC-SYM) were obtained before and at least 24months after surgery for 32 patients only. Post-operative complications were also evaluated using Clavien-Dindo classification at regular interval. The mean operating time per side was 33.9 ± 6.8min and the average hospital stay was 1.9 ± 0.3days. Blood loss was 20cc ± 10cc with no patients needing transfusion. The only significant per-operative complication was hemorrhage (600ml) in one patient induced by a pudendal artery laceration, successfully treated by laparoscopic suturing. Post-operative complications were noted in 18.7% of patients with no serious Clavien-Dindo complications. Perineodynia VAS dropped from 6.8 ± 0.9 to 2.2 ± 1.8 after surgery (p < 0.001). Mean IIEF-5 scores significantly improved one month after the surgery (15.2 vs 19.3, p = 0.036). Mean USP scores significantly improved for the dysuria domain (4.2 vs 1.6, p = 0.021) but not for stress urinary incontinence (3.9 vs 4.1, p = 0.082) or overactive bladder symptoms (14.1 vs 13.8, p = 0.079).Mean PAC-SYM scores significantly improved after the procedure (1.8 vs 1.1, p < 0.001). A complete laparoscopic pudendal nerve and artery release, from the sciatic spine through the Alcock's canal, is a fast and safe surgery with promising functional results. A large prospective trial is needed to validate such an approach.

Pudendal Neurolysis: 6-Step Laparoscopic Approach

To demonstrate the safety and feasibility of the laparoscopic approach to perform pudendal neurolysis in a case of pudendal nerve entrapment syndrome [1-3]. A video tutorial that highlights the laparoscopic steps to performing pudendal neurolysis, with a focus on the main anatomic landmarks [4,5]. A tertiary care regional hospital. This video shows a 6-step approach to laparoscopic pudendal neurolysis for the treatment of pudendal nerve entrapment between the sacrospinous and sacrotuberous ligaments [2,6-8]. Step 1: Identification of the umbilical artery. Step 2: Dissection and development of the lateral paravesical space until the pelvic floor. Step 3: Identification of the arcus tendineus of the endopelvic fascia. Step 4: Identification of the ischial spine and the sacrospinous ligament covered by the coccygeus muscle. Step 5: Coagulation and section of the coccygeus muscle and the sacrospinous ligament. Step 6: Medialization of the pudendal nerve until its entrance into the Alcock canal. This video demonstrates the safety, feasibility, and reproducibility of laparoscopic pudendal neurolysis in 6 steps. A minimally invasive approach is adequate to treat the pudendal compression until the Alcock canal [2].

Laparoscopic treatment of pudendal nerve and artery entrapment improves erectile dysfunction in healthy young males.

Erectile dysfunction (ED) is increasingly becoming more common in young healthy males and is attributed mainly to psychogenic causes in these patients. Recent studies have reported that ED could be secondary to pudendal nerve or artery entrapment. This perspective assessed the efficacy of laparoscopic pudendal nerve and artery decompression in young patients suffering from refractory ED, associated to a pudendal nerve entrapment syndrome. After excluding patients with psychological ED and venous leakage, five young male patients with a history of both ED and pudendal nerve entrapment syndrome diagnosed based on the Nantes criteria were recruited. Pudendal nerve and artery release was performed using a laparoscopic transperitoneal approach. International Index for Erectile Function (IIEF-5) and erectile hardness score (EHS) improved significantly in all patients, 3 months after surgery. Pudendal nerve and artery entrapment could be therefore a reversible cause of ED in young healthy males, and its treatment by laparoscopic pudendal nerve and artery decompression seems to be safe and effective.

Chronic prostatitis: current treatment options.

Male chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is represented by a heterogeneous group of symptoms that can cause an important impairment of daily quality of life for patients. Diagnosis of CP/CPPS is often not clear and treatment can be challenging, as it varies according to the different causative factors and derived symptoms. Differently from approaches used in the past, the diagnosis and subsequent treatment rely on separating this entity from chronic bacterial prostatitis and considering it as a multifactorial disease. Autoimmunity and inflammation, myofascial tenderness, neuroinflammation, and psychological causes have been clearly related to this disease, and therefore CPPS should not only be considered as related to benign prostatic enlargement. A multitude of different symptoms related to urinary, genital, rectal, and perineal areas can be attributed to this condition and therefore should be routinely investigated in patients, as well as possible differential diagnoses which can cause the same symptoms, such as pudendal nerve entrapment syndrome. The aim of this narrative review is to focus on CPPS after an infectious cause has been excluded.

Robot-assisted pudendal neurolysis in the treatment of pudendal nerve entrapment syndrome

IntroductionPudendal nerve entrapment syndrome (PNE) is characterized by the presence of neuropathic pain in the pudendal nerve (PN) territory, associated or not with urinary, defecatory and sexual disorders. Surgical PN decompression is an effective and safe alternative for cases when conservative treatment fails. The aim of this study is to describe the first robot-assisted pudendal neurolysis procedure performed in our country. Material and methodsWe describe step by step the technique of robot-assisted laparoscopic neurolysis of the left PN performed with intraoperative neurophysiological monitoring on a 60-year-old patient diagnosed with left PNE. ResultsThe procedure was performed satisfactorily without complications. After 24h, the patient was discharged from the hospital. We observed a 50% reduction in pain measured using the visual analog scale 2 weeks after the procedure, which remained after 10 weeks of the neurolysis. ConclusionsRobot-assisted neurolysis of the PN constitutes a feasible and safe approach, enabling better visualization and accuracy in the dissection of the PN. Intraoperative neurophysiological monitoring is useful for locating the PN and for detecting intraoperative changes after the release of the nerve.

Proctalgia in Pudendal Nerve Entrapment Syndrome: A Pathology to Know

Background: Pudendal nerve entrapment syndrome is a little known and under-diagnosed condition that includes urinary, sexual and proctological signs and symptoms. Its diagnosis is complex and requires sequential treatment. Proctalgia is a common symptom in the General Surgery field, and it can be attributed to pudendal nerve entrapment syndrome in a significant percentage of patients. Objective: The aim of our study is to determine the association between proctalgia and pudendal nerve entrapment syndrome, to check the immediate response to treatment by infiltration with a corticosteroidanesthetic injection, and to assess the results after 6 months follow-up. Design: An observational study was conducted to assess 53 patients affected by proctalgia in the context of a pudendal nerve entrapment syndrome, who were subjected to treatment with hydrodistentioncorticosteroid- anesthetic infiltration of the pudendal nerve and its terminal branches. Their immediate response, in clinical terms of pain, and after six months of follow-up was assessed. Results: From the data obtained in our study, is was observed that treatment with these injections showed an improvement in 79.25% of the patients in the period immediately after the injection, and 39.62% of patients maintained that improvement after six months. Conclusion: We conclude that, in the presence of proctalgia, the existence of a pudenda nerve entrapment syndrome has to be ruled out, and that treatment with corticosteroidanesthetic infiltration is an effective option that achieves an improvement in a significant percentage of patients.

Management of Bladder Pain Syndrome: Green-top Guideline No. 70.

Management of Bladder Pain Syndrome: Green-top Guideline No. 70.

Pudendal Nerve Entrapment Syndrome due to a Ganglion Cyst: A Case Report.

Pudendal nerve entrapment syndrome is an unusual cause of chronic pelvic pain. We experienced a case of pudendal neuralgia associated with a ganglion cyst. A 60-year-old male patient with a tingling sensation and burning pain in the right buttock and perineal area visited our outpatient rehabilitation center. Pelvis magnetic resonance imaging showed the presence of multiple ganglion cysts around the right ischial spine and sacrospinous ligament, and the pudendal nerve and vessel bundle were located between the ischial spine and ganglion cyst at the entrance of Alcock's canal. We aspirated the lesions under ultrasound guidance, and consequently his symptoms subsided during a 6-month follow-up. This is the first report of pudendal neuralgia caused by compression from a ganglion cyst around the sacrospinous ligament.

Diagnosis and Conservative Chiropractic Care of Chronic Idiopat hic Pudendal Nerve Entrapment Causing Saddle-Like Paresthesia and Restless Genital Syndrome: A Case Study

Introduction: To describe and discuss the diagnosis and chiropractic treatment of a patient with chronic idiopathic pudendal nerve entrapment that presented with saddle-like paresthesia and caused Restless Genital Syndrome. Aim: A 43-year-old female patient had symptoms consistent with a pudendal nerve entrapment, saddle-like paresthesia, and restless genital syndrome for 1.5 years prior to starting care with a chiropractor. She had been to numerous medical providers, none of which offered the correct diagnosis or treatment options. Methods and Results: Chiropractic manipulative therapy, myofascial release, and instrument-assisted soft-tissue mobilization was directed at the pelvic musculature with the primary focus on the right obturator internus. Through one month of chiropractic care the patient’s symptoms were resolved including restoration of regular sexual function. Conclusion: Chronic perineal pain can be found in cases with numerous diagnoses, with pudendal nerve entrapment being one that is rarely documented. There are a wide variety of causes of PNE that include but not limited to direct injury, tumor, ganglion cysts, anatomical anomaly, and extended time cycling. Documented treatment for pudendal nerve entrapment is limited, primarily to pain injections. This case demonstrates how chiropractic care and soft tissue mobilization can correct the dysfunction.

An unusual cause for a rare neuropathy: Pudendal nerve entrapment syndrome secondary to obturator internus muscle edema

An unusual cause for a rare neuropathy: Pudendal nerve entrapment syndrome secondary to obturator internus muscle edema

Magnetic Resonance Imaging-Guided Perineural Therapy as a Treatment Option in Young Adults with Pudendal Nerve Entrapment Syndrome

pudendal neuralgia is a rare chronic neuropathic pain syn-drome in the perineal region. It can be unilateral or bilate-ral and is described as superficial pain, burning sensation or paraesthesia in the anatomical territory of the pudendal nerve which is typically worsened by sitting and barely affects nocturnal sleeping. The incidence is estimated to be 1/100,000 but the etiology and pathogenesis remain incom-pletely understood with hypotheses ranging from mechani-cal nerve injury caused by entrapment (pelvic floor muscle spasm, pressure from surrounding ligaments or scar tissue after trauma, surgery or childbirth) to viral infections or immunological processes [1].

Algorithmes thérapeutiques de la prise en charge des douleurs pelvipérinéales : du syndrome aux traitements

The treatment of patients with chronic pelvic and perineal pain is often complex and involves a number of different parameters. The purpose of this article is to propose a series of treatment algorithms to facilitate the therapeutic management of patients with chronic pelvic and perineal pain. A review of the literature was performed by searching Pubmed for articles on treatment of chronic pelvic and perineal pain. Treatment algorithms were established for each type of pain syndrome. Treatment algorithms were defined for the various types of chronic pain syndrome: pudendal nerve entrapment syndrome, chronic pelvic pain syndrome, painful bladder syndrome, vulvar pain syndrome, epididymotesticular pain syndrome, complex pelvic pain syndrome. Therapeutic management is proposed for each algorithm. The proposed algorithms are designed to be a clinical aid and do not constitute a comprehensive approach to the management of patients with chronic pelvic and perineal pain.

Actualización del síndrome de atrapamiento del nervio pudendo: enfoque anatómico-quirúrgico, diagnóstico y terapéutico

Introduction The syndrome of pudendal nerve entrapment (SANP) is widely unknown and often misdiagnosed or confused with other diseases. It was first described by Amarenco in 1987. The classic clinical manifestation is pudendal neuralgia, a neuropathic pain in the genital area. Objectives To make known its existence to the urology professionals through a systematic review of existing literature and its potential for diagnosis and treatment. Materials and methods We performed a literature search through the database “Pubmed” using the terms “Pudendal nerve”, “Pudendal nerve entrapment syndrome,” “Pelvic floor neuropathic pain”, “Pelvic floor myofascial syndrome,” “Pudendal nerve decompression”. Also, selected works in English, Spanish and French, also reviewing the articles relate this work. Results We develop the highlights of the syndrome: anatomy, etiology, pathophysiology, clinical diagnosis, ecodoppler of internal pudendal artery, electrophysiological studies, diagnostic criteria, medical therapy, physical therapy treatments and surgery. Conclusion It is an uncommon cause of pain in the pelvic floor and greatly affects quality of life of patients. Today, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results.

Síndrome de atrapamiento del nervio pudendo

Pudendal nerve entrapment syndrome is a poorly known condition and thus rarely included in our differential diagnoses. First described by Amarenco in 1987. The symptomatology is varied and can be confused with other entities, in particular the pelvic floor myofascial syndrome. The main symptom is neuropathic pain in the perineal area. The diagnosis is based on the clinical history, physical examination and the confirming neurophysiologic tests.