Relief of Urinary Urgency, Hesitancy, and Male Pelvic Pain with Pulse Radiofrequency Ablation of the Pudendal Nerve: A Case Presentation (original) (raw)
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Asymmetrical pudendal nerve damage in pelvic floor disorders
International Journal of Colorectal Disease, 1988
Differences in the left and right pudendal nerve terminal motor latencies have been observed in patients with pelvic floor disorders. Until now the mean value of the left and right pudendal latencies has been used as the index of pudendal neuropathy. In 22 patients of a group of 156 patients studied the pudendal nerve terminal motor latency was abnormally raised on one side only. These patients are thought to have pudendal neuropathy whether or not the mean value of the left and right pudendal latencies is also raised. This observation may have therapeutic implications.
Pelvic Pain of Pudendal Nerve Origin: Surgical Outcomes and Learning Curve Lessons
Journal of Reconstructive Microsurgery, 2015
Reconstructive microsurgery may directly involve the pudendal nerve during vaginal reconstruction, 1-4 groin hydradenitis suppurativa reconstruction, 5,6 rectal reconstruction, 7-9 transgender reconstruction, 10-12 inferior gluteal artery perforator flaps for breast reconstruction, 13-16 labial reconstruction, 17-19 salvage procedures after gynecologic mesh interventions for urinary incontinence, 20-22 and following urologic procedures such as prostatectomy. Injury to the branches of the pudendal nerve results in pain syndromes that have proven difficult to treat, with success rates for the most commonly done surgical approach having an expectation that 70% of patients will improve by > 2 on a 10-point Likert scale, and just 20% achieving an excellent result (►Table 1). Recognizing that peripheral nerve surgery is the basis for treatment of refractory pelvic pain related to the pudendal nerve, it is incumbent for the reconstructive microsurgeon to approach the problem from the standpoint of (1) determining that the pudendal nerve is the nerve primarily transmitting Keywords ► pudendal nerve ► neurolysis ► neuroma
International Neurourology Journal
Pudendal neuralgia (PN) is a painful and disabling condition, which reduces the quality of life as well. Pudendal nerve infiltrations are essential for the diagnosis and the management of PN. The purpose of this study was to compare the effectiveness of finger-guided transvaginal pudendal nerve infiltration (TV-PNI) technique and the ultrasound-guided transgluteal pudendal nerve infiltration (TG-PNI) technique. Methods: Forty patients who underwent PNI for the diagnosis of PN were evaluated. Thirty-five of these 40 patients, who were diagnosed as PN, underwent a total of 70 further unilateral PNI. All the patients underwent PNI for twice after the first diagnostic PNI, 1 week apart. Results: In the ultrasound (US)-guided TG-PNI group, the success rate was 68.8% (11 of 16) in both "pain in the sitting position" and "pain in the region from the anus to the clitoris. " The success rate of blocks in the US-guided TG-PNI group was 75% (12 of 16) in terms of pain during/after intercourse. In the finger-guided TV-PNI group, the success rate was 84.2% in both "pain in the sitting position" and "pain in the region from the anus to the clitoris. " The success rate of blocks in the fingerguided TV-PNI group was 89.5% (17 of 19) in terms of pain during/after intercourse. There was no statistically significant difference in the success rate of the 3 assessed conditions between the 2 groups (P > 0.05). Conclusions: The TV-PNI may be an alternative to US-guidance technique as a safe, simple, effective approach in pudendal nerve blocks.
Neurorehabilitation and Neural Repair, 2008
Background. Detrusor-sphincter dyssynergia is a condition in which reflexive contractions of the external urethral sphincter occur during bladder contractions, preventing the expulsion of urine. High-frequency stimulation (kHz range) has been shown to elicit a fast-acting and reversible block of action potential propagation in peripheral nerves, which may be a useful technique in the management of this condition. Objective. The aim of these experiments was to see if a newly developed stimulus delivery system, capable of transmitting current transcutaneously to remote peripheral nerves using a passive implanted conductor, was an effective way to transmit high-frequency waveforms to the pudendal nerve to block ongoing sphincter contractions. Methods. High-frequency waveforms were delivered through the skin to the pudendal nerve using a passive implanted conductor in 6 adult cats anesthetized with isoflurane. Five of the experiments were acute, terminal procedures, and the remaining ca...
Laparoscopic uterosacral nerve ablation for alleviating chronic pelvic pain
JAMA: the journal of …, 2009
women is as common as asthma and chronic back pain, 1,2 is one of the most difficult and perplexing of women's health problems, and has a multifactorial etiology. 3 Chronic pelvic pain has a major effect on health-related quality of life, work attendance and productivity, 4 and health care use, accounting for 40% of referrals for diagnostic laparoscopy, 5 and is an important contributor to health care expenditures. 6 Treatments for chronic pelvic pain are often unsatisfactory. 7 As part of the evaluation and management phase, patients often undergo diagnostic laparoscopy 8 but actionable pathology is found only occasionally. 9,10 Negative findings at laparoscopy and during follow-up with ultrasound may provide re
Neurourology and Urodynamics, 2005
Aims: The objective of the study was to compare sacral nerve stimulation (SNS) to pudendal nerve stimulation (PNS) for voiding dysfunction. Methods: Thirty subjects with voiding dysfunction had a tined lead placed at S3 and a second electrode implanted at the pudendal nerve via a posterior approach. In a blinded, randomized fashion, each lead was tested for 7 days. Voiding diaries and questionnaires were completed and outcomes monitored. Results: The time to place a sacral lead was 25.85 min, pudendal lead 23.71 min (P ¼ 0.57). Twenty-four of 30 (80%) subjects responded and had a permanent implant placed. PNS was chosen as a superior lead in 79.2%, SNS was superior in 20.8%. The order in which the lead was simulated had no impact on the ¢nal lead implanted and no carry over e¡ect was seen. Overall reduction in symptoms was 63% for PNS and 46% for SNS (P ¼ 0.02). On a 7-point scale from markedly worse to markedly better, the pudendal lead was superior to sacral for pelvic pain (P ¼ 0.024), urgency (P ¼ 0.005), frequency (P ¼ 0.007), and bowel function (P ¼ 0.049). Complications were minimal. Conclusions: This is the ¢rst blinded study of sacral versus pudendal stimulation for voiding dysfunction. Successful implantation of a pudendal lead was achieved in all subjects. The majority of subjects chose PNS to be superior to SNS. More patients and longer term data is needed to con¢rm these promising results. Neurourol. Urodynam. 24:6436 47, 2005. ß 2005 Wiley-Liss, Inc.