Ultrasound-guided injections in pelvic entrapment neuropathies (original) (raw)
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CT-guided Perineural Injections for Chronic Pelvic Pain
Radiographics : a review publication of the Radiological Society of North America, Inc
Chronic pelvic pain is a disabling condition that affects a large number of men and women. It may occur after a known inciting event, or it could be idiopathic. A common cause of pelvic pain syndrome is neuropathy of the pelvic nerves, including the femoral and genitofemoral nerves, ilioinguinal and iliohypogastric nerves, pudendal nerve, obturator nerve, lateral and posterior femoral cutaneous nerves, inferior cluneal nerves, inferior rectal nerve, sciatic nerve, superior gluteal nerve, and the spinal nerve roots. Pelvic neuropathy may result from entrapment, trauma, inflammation, or compression or may be iatrogenic, secondary to surgical procedures. Imaging-guided nerve blocks can be used for diagnostic and therapeutic management of pelvic neuropathies. Ultrasonography (US)-guided injections are useful for superficial locations; however, there can be limitations with US, such as its operator dependence, the required skill, and the difficulty in depicting various superficial and de...
Anatomical basis of chronic pelvic pain syndrome: the ischial spine and pudendal nerve entrapment
Medical Hypotheses, 2002
Antolak SJ Jr, Hough DM, Pawlina W, Spinner RJ: Anatomical basis of chronic pelvic pain syndrome: the ischial spine and pudendal nerve entrapment. Chronic pelvic pain syndrome is a conundrum that may be explained partly by pudendal nerve entrapment (PNE), which causes neuropathic pain. In men with PNE, aberrant development and subsequent malpositioning of the ischial spine appear to be associated with athletic activities during their youth. The changes occur during the period of development and ossification of the spinous process of the ischium.
Neuromodulation: Technology at the Neural Interface, 2006
The aim of the study was to test the effectiveness of sacral nerve stimulation (SNS) performed by a transforamenal approach in patients with isolated chronic intractable pelvic pain. Materials. Seven patients with intractable pelvic pain underwent implantation of self-anchoring leads by way of the dorsal S3 foramen in four cases and of the dorsal S4 foramen in three cases. Patients with pain improvement > 50% underwent sacral nerve root stimulation device implantation. SNS therapeutic efficacy was measured using a visual analog scale (VAS) and its effects on quality of life (QoL) using the SF-36 scale. Results. During test stimulation five patients had significant and permanent pain relief and subsequently underwent implantation of a permanent device. VAS score improvement was evident in these patients and remained unchanged at 3, 6, and 12 months (median 8 months); SF-36 QoL questionnaire also revealed significant improvement in many domains of QoL including all the four physical domains and three of the four mental domains. There were three complications in our seven patients: one lead fracture, one lead displacement in the presacral space, and one patient who developed pain at the implantable pulse generator site. Conclusions. Transforamenal SNS is effective in relieving isolated pelvic pain but a high complication rate was found.
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
The Pain Cycle: Implications for the Diagnosis and Treatment of Pelvic Pain Syndromes
International Urogynecology Journal and Pelvic Floor Dysfunction, 2001
The aim of the study was to report our results of sacral nerve stimulation in patients with pelvic pain after failed conservative treatment. From 1992 to August 1998 we treated 111 patients (40 males, 71 females, ages 46 + 16 years) with chronic pelvic pain. All patients with causal treatment were excluded from this study. Pelvic floor training, transcutaneous electrical nerve stimulation (TENS) and intrarectal or intravaginal electrostimulation were applied and sacral nerve stimulation was used for therapy-resistant pain. The outcome of conservative treatment and sacral nerve stimulation (VAS <3/10; >50% pain relief) was related to symptoms of voiding dysfunction and dyschezia, and urodynamic proof of dysfunctional voiding, not to the pain localization or treatment modality. Outcome was inversely related to neuropathic pain. When conservative treatment failed, a test stimulation of the S3 root was effective in 16/26 patients, and 11 patients were implanted successfully with a follow-up of 36 + 8 months. So far no late failures have been seen. A longer test stimulation is needed in patients with pelvic pain because of a higher incidence of initial false positive tests. Our conclusion is that sacral nerve stimulation is effective in the treatment of therapy-resistant pelvic pain syndromes linked to pelvic floor dysfunction.
Nerve Entrapment - An Important Complication of Transverse Lower Abdominal Incisions
The Australian and New Zealand Journal of Obstetrics and Gynaecology, 1994
Eleven patients with atypical lower abdominal pain following gynaecological surgery were clinically assessed for the features of nerve entrapment syndrome. Eight iliohypogastric nerves in 6 patients were subsequently explored and divided with satisfactory results in all patients. Diagnostic criteria for this syndrome are suggested, and the surgical management is described. 5% AUST. AND N.Z. JOURNAL OF OBsrETRiCS AND GYNAECOWGY 2. Harms BA, De Haas DR, Starling JR. Diagnosis and management of genitofemoral neuralgia. Arch Surg 1984; 119 339-341. 3. Magee RK. Genitofemoral causalgia (new syndrome). Can Med A s m J 194% 46: 326-329. 4. Sippo WC, Burghardt A, Gomez AC. Nerve entrapment after Pfannenstiel incisions. Am J Obstet Gynecol 1987; 157: 420-421. 5. Sippo WC, Gomez AC. Nerve entrapment syndromes from lower abdominal surgery. J. Fam Pract 1987; 25: 585-587. 6. Gallegos NC, Hobsley M. Abdominal wall pain: an alternative diagnosis. B J Surg 1990; 77: 1167-1170. 7. Miyazaki F, Shok J. Ilioinguinal nerve entrapment during needle suspension for stress incontinence. Obstet Gynecol 1992; 80: 8. Knockaert DC, D'Heygere FG, Bobbaers HJ. llioinguinal nerve entrapment: a little known cause of iliac fossa pain. Postgrad Med J 1989; 65: 632-635. 9. Hahn L. Clinical findings and results of operative treatment in ilioinguinal nerve entrapment syndrome. Br J Obstet Gynaecol 1980; 9 6 1080-1083.
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