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Of all treatments adopted in the frame of PN, the most cited treatments are based on local infiltration targeted to the pudendal nerve and pudendal nerve decompression through surgery (including radiofrequency).
- Introduction
- Materials and Methods
- Results
- Discussion
- Conclusions
Pudendal neuralgia is an increasing multifactorial condition, with a heavy impact on patient's quality of life. It consists of chronic perineal pain along the course of pudendal nerve, variably described by the patient, as mono, or bilateral, sometimes radiating to gluteus, genitals, or thighs . The incidence is documented at 1% of the general popu...
Study Population and Inclusion Criteria
Patients were recruited from our outpatient clinic, from January 2011 to September 2012 and selected according to the following protocol: 1. Clinical diagnosis of pudendal neuralgia with presence of all Nantes essential criteria and at least one complementary sign; 2. Failure of 3 months medical therapy, based on 150 mg/day Pregabalin (Lyrica®, Pfizer Ltd, Latina, Italy) and 30 mg/day ketorolac tromethamine (Toradol®, Recordati s.p.a., Milan. Italy); 3. Evaluation of VAS score and quality of...
Lipofilling Technique
Preoperatively, whole-bowel washing was performed and the patient received routine antibiotic prophylaxis, with a single shot of cefotaxime 2 g at the time of surgery. All patients were operated in the lithotomy position. We used the original Coleman's technique, based on three stages: fat harvesting, purification of lipoaspirate with centrifugation, and infiltration in the site of treatment , Fat donor sites were lower abdomen, flank, thighs, knee, and gluteal region. After tumescent injecti...
Outcome Measures
We considered the incidence of recurrent pudendal neuralgia (VAS > 5) at clinical examination as the primary outcome measurement. A nurse as independent observer administered VAS and SF-36. VAS was collected at 7 and 14 days and 1, 3, 6, 12 months after the operation; each patient was recalled at the right time after her/his date of surgery. SF-36 was scheduled at 3, 6, and 12 months. PNTML was repeated 12 months after the treatment. Patients who did not strictly follow the pre and/or postope...
Preoperative Data
Out of 20 patients with pudendal neuralgia observed from January 2011 to September 2012, five were not eligible for the study: one for an anal fissure, one for pelvic endometriosis, one for prostatitis, and two for the coexistence of a psychiatric disorders. The other 15 (14 women, median age 60 ± 7 years, range 48–69) were enrolled: eight of them have had previous pelvic floor surgery (5 haemorrhoidectomy, 2 hysterectomy, 1 colpoperineorrhaphy), two had undergone a pelvic trauma, and one was...
Operative Data
Mean operating time was 91.5 (10.1) minutes. Quantity of lipoaspirate was 19.7 (0.52) mL and two or three fat donor sites were chosen for each patient, namely lower abdomen in 15/15 patients, knee in 10, flank in 5, and gluteal region in 2/15. There was no operative mortality, or complications. All patients were discharged during the first postoperative day. No patients needed more than Acetaminophen 1,000 mg/day plus codein 60 mg/day for pain control during the hospital stay.
Follow-up Data
Two patients had no improvement of pain and continued to use analgesic drugs. Three patients were lost during follow-up. Ten patients were free of pain within 12 months after the procedure with VAS > 5. As shown in Table 0001 pain significantly decreased (VAS 3.2 ± 0.6 vs 8.1 ± 0.9 in preoperative evaluation, P< 0.001): pain reduction was progressive until 6 months after the operation, while a slight reversal of the trend was observed 12 months after the operation, characterized by a mild wor...
Pudendal neuralgia is an infrequent condition and Literature on the argument is scanty, particularly regarding the best treatment. Most patients address social forums to share their experience in the hope of finding an effective solution. The clinical diagnosis, based on the Nantes criteria, may be confirmed by neurophysiologic tests, with delayed ...
In our experience, the pudendal nerve lipofilling turned out to be easy to perform, safe, and effective, with significant and persistent improvement of symptoms. Furthermore, in the event of pain recurrence the procedure can be repeated. However, being a limited preliminary study our observation must be confirmed by more extensive experiences with ...
- Marco Venturi, Paolo Boccasanta, Bruno Lombardi, Max Brambilla, Ettore Contessini Avesani, Contardo ...
- 2015
Nov 11, 2022 · Pudendal neuralgia is chronic pelvic pain caused by an irritated or damaged pudendal nerve. Your pudendal nerve runs from the back of your pelvis to all the muscles and skin in your genital area, including your anus, vagina and penis. Treatment options include medication, physical therapy, lifestyle changes or surgery.
May 17, 2024 · Damage to the pudendal nerve can result from surgical procedures, childbirth, trauma, spasms of the pelvic floor muscles, or tumors. Pudendal Neuralgia may also result from certain infections (such as herpes simplex infections) or certain activities (such as cycling and squatting exercises).
The key is to find a surgeon who has a really good understanding of PN, and can help you rule it in/out because you want to be pretty damn confident you have it before undergoing a pudendal nerve decompression.
I also read that pelvic floor physical therapy, which I am in now, only really helps to treat spasms/spastic muscles, and can do nothing to actually decompress or un-entrap the pinched nerve. I read that falls can actually cause scar tissue because of bruising.
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The surgeons at The Institute for Advanced Reconstruction are recognized as leaders in the diagnosis and treatment of pudendal neuralgia, relieving intense pelvic pain with nerve decompression surgery and more.
