Materiały źródłowe

• #1 Pudendal Neuralgia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562246/

  Pudendal neuralgia is a chronic pelvic and perineal pain syndrome originating from damage, injury, inflammation, or irritation of the pudendal nerve. […] Pudendal neuralgia is the neuropathic pain component of the syndrome caused by pudendal nerve entrapment and neuropathy. […] Compression of the pudendal nerves, which may be severe, is the most common pathophysiologic cause of PN., which is typically visible to the surgeon during decompression and transposition surgeries. […] Congenital nerve compression is frequently noted when aberrant fascias are present, and the nerve travels through the sacrotuberous ligament. […] Acquired compressions include scarring after pelvic surgeries, direct trauma following repetitive or serious falls (eg, skiers, skaters, snowboarders, and other athletes), or excessive sitting (eg, cyclists). […] A hypertrophied obturator internus muscle can also compress the nerve in the pudendal canal. […] Stretching of the pudendal nerves is occasionally observed as well.

• #2 Pudendal Neuralgia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/40740

  Pudendal neuralgia is the neuropathic pain component of the syndrome caused by pudendal nerve entrapment and neuropathy. The pudendal nerve is a mixed nerve having sensory, motor, and autonomic functions. As a result, inflammation or injury to the nerve can cause bladder, bowel, sexual and autonomic dysfunctions and perineal pain. Injuries typically affect pelvic and perineal sensations more severely than motor or autonomic nerve functions. Pudendal neuralgia is generally a bilateral process characterized by perineal pain aggravated by sitting and affects 50% of patients with pudendal nerve entrapment. The condition is frequently misdiagnosed initially and is often refractory to treatment, causing intense, chronic, debilitating pain. […] Pudendal neuralgia is generally a clinical diagnosis that is suggested by characteristic features, sometimes referred to as the „Nantes” criteria. However, pudendal neuralgia is usually diagnosed only after many years of painful symptoms, with patients having undergone multiple evaluations, medication trials, procedures, interventions, and even surgeries.

• #3 Pudendal Nerve Entrapment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544272/

  Pudendal neuralgia caused by pudendal nerve entrapment is chronic, severely disabling, neuropathic pain in the distribution of the pudendal nerve in both males and females. […] Pudendal neuralgia can arise from mechanical or non-mechanical injuries. […] The mechanical injury can be due to compression, transaction, or stretching. Amongst the mechanical causes, compression caused by pudendal nerve entrapment is the most common etiology. […] Direct compression of the pudendal nerve is often visible to the surgeon at the time of decompressive surgery. While repetitive actions such as sitting and cycling are primarily responsible, nerve compression may be congenital or the result of scarring after pelvic surgeries. […] Pudendal nerve entrapment syndromes are subdivided into four types based on the location of the compression.

• #3 Pudendal Nerve Entrapment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544272/

  The first reported case of pudendal neuralgia was due to cycling, which resulted from continuous pressure on Alcock’s canal. […] Pudendal nerve entrapment is a rare syndrome, and its true prevalence is unknown. […] The overall response to pudendal nerve blocks in properly selected patients is roughly 80%, but the relief typically lasts only about 30 days in most patients. […] The best long-term cures are from decompressive surgery, where the response rates are 60% to 80%. […] Pudendal neuralgia due to pudendal nerve entrapment can immensely affect the quality of life, but it does not affect life expectancy.

• #4 Pudendal nerve neuralgia: Awakening to an underestimated reality – International Journal of Case Reports and Images (IJCRI)

  https://www.ijcasereportsandimages.com/archive/article-full-text/101300Z01MO2022

  Pudendal neuralgia can arise as a result of mechanical or non-mechanical injury. Mechanical injury can be caused by compression, transaction, or stretching. Among mechanical causes, compression caused by incarceration of the pudendal nerve is the most common cause. Non-mechanical causes of pudendal neuropathy include viral infections such as herpes zoster and human immunodeficiency virus (HIV); multiple sclerosis; diabetes mellitus, among others. […] The physical examination of these patients is relatively normal, except for the reproduction of pain. Symptoms depend on the site of compression and the diagnosis is essentially clinical, corroborated by neurophysiological tests. […] The intervention strategies for this condition include prophylactic behavioral changes (mitigation of pain triggering factors); pelvic floor physiotherapy; pharmacological therapy with Gabapentin, Pregabalin and tricyclic antidepressants; pudendal nerve blocks; surgical decompression considered the best treatment for pudendal neuralgia and neuromodulation.

• #5 Pudendal Neuralgia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/40740

  Pudendal neuralgia (PN) is generally a „tunnel” syndrome, typically resulting from cumulative, repetitive microtrauma to the nerve. Furthermore, bony remodeling in the pelvis commonly occurs secondary to repetitive overuse of pelvic floor muscles, resulting in changes to the ischial spine and the inferior lateral angle of the sacrum. When untreated and nerve damage advances, pudendal neuropathy can progress from minor localized symptoms, most commonly the bladder, to more painful generalized symptoms. Severe pain may occur in several areas and is often confused with various structural and organ diseases. […] Compression of the pudendal nerves, which may be severe, is the most common pathophysiologic cause of PN., which is typically visible to the surgeon during decompression and transposition surgeries. Congenital nerve compression is frequently noted when aberrant fascias are present, and the nerve travels through the sacrotuberous ligament. Acquired compressions include scarring after pelvic surgeries, direct trauma following repetitive or serious falls (eg, skiers, skaters, snowboarders, and other athletes), or excessive sitting (eg, cyclists). A hypertrophied obturator internus muscle can also compress the nerve in the pudendal canal. Stretching of the pudendal nerves is occasionally observed as well.

• #6 Pudendal nerve entrapment syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/pudendal-nerve-entrapment-syndrome?lang=us

  Pudendal nerve entrapment (PNE) syndrome is a rare and under-diagnosed condition associated with chronic pain, sexual dysfunction and impaired sphincter control due to pudendal nerve compression. […] In the setting of an entrapment syndrome, the nerve is compressed from injury, repetition, or adjacent structures. […] Four types of PNE syndromes have been identified based on the site of entrapment. […] Pudendal nerve entrapment syndrome is primarily a clinical diagnosis. […] Improving pain symptoms in response to a pudendal nerve block may also assist in confirming the diagnosis. […] Inflammation of a compressed pudendal nerve may be demonstrated on T2 weighted MRI as edematous swelling and hyperintensity, in addition to kinking or a change in the thickness of the nerve. […] Clinical improvement in response to a pudendal nerve block may confirm a diagnosis of pudendal neuralgia as the cause of symptoms. […] Surgical decompression is a potential treatment for entrapment.

• #7 :: ICU :: Investigative and Clinical Urology

  https://icurology.org/DOIx.php?id=10.4111/icu.20230402

  According to the updated European Association of Urology guidelines, nerve decompression through PNN is particularly recommended for carefully selected patients who have failed conservative therapies for chronic pelvic pain associated with PNE. […] Nerve decompression is the only option that ensures long-term outcomes. […] Compression, transection, or stretching of the pudendal nerve are commonly reported and can occur through entrapment in Alcocks canal. […] The pudendal nerve can be entrapped at various anatomical levels, causing chronic pain in the perineum, genitals, and anorectal region. […] Using physical examination maneuvers and diagnostic imaging such as magnetic resonance (MR) neurography and open MR image-guided injections, Filler identified four main locations of entrapment during the pudendal pathway, that reflect the four principal types of the pudendal neuralgia.

• #7 :: ICU :: Investigative and Clinical Urology

  https://icurology.org/DOIx.php?id=10.4111/icu.20230402

  Among these sites, the authors identified type III entrapment in the Alcock canal as the most common cause of PNE in their series (80%), with obturator internus spasm playing a significant role. […] Multiple sites of entrapment may be interested in determining variable clinical manifestations. […] The relationship between symptoms and the site of entrapment plays a role in choosing the appropriate surgical approach. […] The pudendal nerve becomes excited, as the bladder fills, with subsequent external urethral sphincter contraction. […] Therefore, it is not surprising to consider that pudendal neuropathy can also impair the micturition. […] PNE should be considered a potential underlying cause in patients with LUTS refractory to medical therapy. […] Both transperitoneal and transgluteal surgeries seem to offer a safe and highly effective therapeutic option for patients experiencing debilitating pain and intractable LUTS that significantly impact their quality of life.

• #7 :: ICU :: Investigative and Clinical Urology

  https://icurology.org/DOIx.php?id=10.4111/icu.20230402

  The pudendal nerve plays a crucial role in penile erection. […] The somatic afferent pathway of the pudendal nerve innervates the glans and penile skin through both the peripheral and central components of the dorsal nerve pathway. […] The somatic efferent pathway innervates the ischio- and bulbocavernosus muscles that surround the corporal bodies, while the autonomic efferent pathway innervates the smooth muscles surrounding the helicine arterioles and lacunar spaces, forming the pelvicavernous nerve pathway. […] PNN plays a pivotal role in attaining dryness by resolving SUI and reinstating external anal sphincter functionality. […] Concerning sexual function, the recovery of the somatic afferent pathway culminates in an improvement in erectile function within the early months post-surgery.

• #8 Pudendal nerve entrapment syndrome (PNE) – GPnotebook

  https://gpnotebook.com/en-GB/pages/general-information/pudendal-nerve-entrapment-syndrome-pne

  pudendal neuralgia („Alcock canal syndrome”) is a symptom caused by pudendal neuropathy such as bowel, bladder, and sexual dysfunction, in addition to pain in the distribution of the pudendal nerve that is exacerbated on sitting. […] possible causes of pudendal neuralgia include excessive bicycling (often known as the „cyclist syndrome”), pregnancy, anatomic abnormalities, scarring due to surgery, or as a sequela of radiation therapy. […] pudendal neuropathy secondary to nerve entrapment causes neuropathic pain with varying degrees of pain intensity in the S3-S4 dermatome. […] pudendal nerve become entrapped at several points along its course leading to intractable pelvic and perineal hyperalgesia. […] performance of a pudendal nerve block can serve as both a diagnostic and therapeutic tool. […] imaging studies (for example MRI, MR neurography of the lumbosacral plexus and pelvic nerve branches), as well as the performance of an electrophysiological study with pudendal nerve motor latency testing, may yield valuable evidence in support of a pudendal neuralgia diagnosis.

• #9 Pudendal Neuralgia (PN) – Symptoms, Causes, Diagnosis, & Treatment

  https://www.myprivia.com/gynpain/services/pudendal-neuralgia

  Pudendal neuralgia can be caused by various mechanisms. These can be separated into three basic categories: […] The pudendal nerve is anatomically vulnerable to compression and entrapment along its course. Patients with anatomical predispositions (i.e. smaller canals, a narrow window between ligaments, etc.) or biomechanical abnormalities are more susceptible to compression injuries. […] The pudendal nerve is also vulnerable to tension injuries. A variety of factors can put undo tension on the nerve causing it to lengthen beyond its normal limits and result in neural inflammation. Possible factors include vaginal childbirth, constipation with repetitive straining to defecate and squatting with heavy weights. Pelvic floor dysfunction, genital prolapse, and so-called descending perineum syndrome can also contribute to nerve tension injury. Fixation along the nerve pathway will result in the nerve becoming more likely to be injured with any of the above factors.

• #9 Pudendal Neuralgia (PN) – Symptoms, Causes, Diagnosis, & Treatment

  https://www.myprivia.com/gynpain/services/pudendal-neuralgia

  Pudendal neuralgia (also known as Alcocks syndrome, Pudendal Canal Syndrome) is a condition caused by an entrapment, compression or tension of the pudendal nerve resulting in pain in the distribution of the pudendal nerve. […] The exact mechanism of nerve dysfunction and damage is dependent on its etiology. For patients with nerve entrapment and compression, an inflammatory response is engendered. This results in venous stasis increased vascular permeability and eventually demyelination. This can result in scar formation and in cases of severe injury, permanent nerve damage. […] For patients with nerve tension injury, the inflammatory effect is not as severe and demyelination is not a factor. However, the neuronal function is impaired. For patients with fixation along the nerves course, an injury will be more common because the nerve lacks mobility and is more readily stretched. Also, pelvic floor dysfunction itself may cause pain along the pudendal nerve distribution.

• #10 Pudendal nerve entrapment – Wikipedia

  https://en.wikipedia.org/wiki/Pudendal_nerve_entrapment

  Therefore, pudendal neuralgia is the neuropathic pain component of a chronic pelvic pain syndrome that is sometimes (but not always), associated with compression and subsequent neuropathy (nerve damage) of the pudendal nerve. […] Prolonged pressure on the pudendal nerve and chronic traction (stretching) injuries interrupt the normal microvasculature (blood supply via small blood vessels) of the pudendal nerve, triggering a cascade of physiological changes. Firstly, there is a breakdown of the blood-nerve barrier. Secondly, edema and connective tissue changes occur. This is followed by diffuse demyelination, and finally by Wallerian degeneration. In the acute form, a metabolic block by an impaired blood supply will interrupt normal function of the pudendal nerve. In the chronic form, neuropraxia and axonmetesis (Sunderland type 1 and 2) injuries will create positive symptoms (e.g. pain and paresthesias) and negative symptoms (loss of sensation). The damage is cumulative. […] Pudendal nerve entrapment is thought to be the most common cause of pudendal neuralgia. Others state that traction neuropathy (nerve damage resulting from stretching) is the most common cause of pudendal neuralgia rather than entrapment.

• #11 Pudendal Neuralgia | GLOWM

  https://www.glowm.com/section-view/heading/Pudendal%20Neuralgia/item/691

  Injury of the nerve(s) may be uni- or bilateral, although unilateral injury seems to be more common. Indeed, it has also been hypothesized that pudendal nerve injury may be responsible for inducing an increase in the C-fiber pathway of the bladder, leading to urinary urge incontinence and to the development of overactive bladder syndrome. […] Neuropathic pain is commonly described as pins and needles, burning, cold, numbness, or itching. Symptoms are secondary to lesions directly affecting the somatosensory system. […] When peripheral nerves are injured, abnormal regeneration can lead to spontaneous ectopic activity in sensory neurons. Thus, regenerating neurons become hypersensitive and develop pathological activity such as abnormal excitability and heightened sensitivity to chemical, thermal, and mechanical stimuli. This phenomenon is called peripheral sensitization.

• #11 Pudendal Neuralgia | GLOWM

  https://www.glowm.com/section-view/heading/Pudendal%20Neuralgia/item/691

  In contrast, central sensitization develops from increased responsiveness of neurons in the dorsal horn of the spinal cord. Increased intracellular calcium conducted by N-methyl-D-aspartate (NMDA) receptors enhances synaptic inputs by increasing the number of synapses on dorsal horn neurons. This enhancement leads to neuronal excitability, thereby responding to noxious and innocuous stimuli. Central sensitization also produces allodynia and hyperalgesia similar to peripheral sensitization. […] It appears that CRPS II is caused by a physiological wind up and central nervous system sensitization, mediated by up-regulation of NMDA receptor. Intense or prolonged painful stimuli cause an exaggerated release of glutamate from peripheral nociceptive afferents located within dorsal horn neurons within the spinal cord. The glutamate then stimulates NMDA receptors on the second-order neurons, thereby producing the phenomena of central sensitization.

• #12 Pudendal Neuralgia | GLOWM

  https://www.glowm.com/section-view/heading/Pudendal%20Neuralgia/item/691

  Pudendal neuralgia may arise from five distinct mechanisms. First, there may be a direct injury to the nerve. Second, pelvic floor muscles spasm, or pelvic floor tension myalgia, may cause compression of the nerve. Third, pelvic floor muscle spasm alone, without pudendal neuropathy, may also mimic pudendal neuralgia symptoms. Fourth, biochemical injury from infection or disease may occur. Finally, there may be compression of the spinal cord or nerve roots. […] Mechanical injury occurs from compression, stretching or transection of the nerve. Compression, termed pudendal nerve entrapment, is the most common form of mechanical injury. […] Although the terms pudendal nerve entrapment and pudendal neuralgia have been used interchangeably, caution must be taken labeling patients with pudendal nerve entrapment without evidence of mechanical compression.

• #12 Pudendal Neuralgia | GLOWM

  https://www.glowm.com/section-view/heading/Pudendal%20Neuralgia/item/691

  Biochemical or nonmechanical causes of pudendal neuropathy are uncommon. Case reports, as well as evidence from our own clinical experience, confirm the development of pudendal neuralgia from viral infection (herpes zoster, HIV), diabetes, multiple sclerosis, and others. Treatment for this group of patients is directed toward treating the underlying disease. Nevertheless, neuralgia may persist even after treatment.

• #13 Pudendal Neuralgia: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24438-pudendal-neuralgia

  Pudendal neuralgia (or pudendal nerve entrapment) is when you experience chronic pelvic pain from damage or irritation to your pudendal nerve. If you have pudendal neuralgia, this nerve is injured or compressed and causes stabbing, burning or shooting pain. The pain can be felt in your buttocks, perineum and genital region, and is more severe when sitting. […] Pudendal neuralgia can occur when the pudendal nerve is damaged (by pressure or other irritation) or compressed, often by surrounding tissues or muscles. Some causes include: Activities that place constant strain on the pelvic area. Cycling, squatting exercises, horseback riding or chronic constipation are examples of constant or prolonged strain that could damage your pelvis. […] Physical therapy, medication, lifestyle changes or surgery are possible treatments for pudendal neuralgia. Providers may combine treatments for quicker relief from symptoms.

• #14 Understanding Pudendal Nerve Injury During Childbirth: Causes, Symptoms, and Effective Treatments — Expecting Pelvic Health

  https://www.expectingpelvichealth.com/blog-posts/understanding-pudendal-nerve-injury-during-childbirth

  Pudendal nerve injury is a relatively unknown but significant complication that can occur during childbirth, particularly after a difficult vaginal delivery. […] Injury to this nerve during childbirth can lead to a variety of pelvic floor dysfunctions, including incontinence, sexual dysfunction, and chronic pelvic pain. […] Pudendal nerve injury during childbirth is primarily linked to prolonged or difficult labor, instrumental deliveries, and specific maternal anatomical or obstetric factors. […] The injury is usually the result of excessive stretching or compression of the nerve, which is vulnerable to injury during the second stage of labor when the fetal head descends through the birth canal. […] A prolonged second stage of labor, where the fetal head remains in the birth canal for an extended period, increases the likelihood of pudendal nerve compression.

• #14 Understanding Pudendal Nerve Injury During Childbirth: Causes, Symptoms, and Effective Treatments — Expecting Pelvic Health

  https://www.expectingpelvichealth.com/blog-posts/understanding-pudendal-nerve-injury-during-childbirth

  Forceps and vacuum-assisted deliveries are major risk factors for pudendal nerve damage. […] Delivering a large baby (fetal macrosomia) increases the mechanical strain on the maternal pelvis and pelvic floor, leading to increased risk of nerve injury. […] Severe perineal tears, especially third- and fourth-degree tears, are associated with pudendal nerve damage. […] Symptoms of pudendal nerve injury can range from mild discomfort to significant dysfunction. […] Chronic pelvic pain is one of the hallmark symptoms of pudendal nerve injury. […] Damage to the pudendal nerve can lead to urinary and fecal incontinence due to impaired function of the pelvic floor muscles. […] Pudendal nerve injury can cause decreased sensation in the genital area, leading to difficulties with sexual arousal and orgasm.

• #15 Pudendal Neuralgia – Diagnosis & Treatment

  https://ainasc.com/conditions/pudendal-neuralgia/

  Pudendal neuralgia can be caused by any one of a diverse group of mechanisms. […] Childbirth – most common cause […] Entrapment – Pinched nerve […] Trauma – fracture of the ischial spine, penetration with a large dull needle, surgery (direct injury to pudendal nerve or residual scar in the vicinity) […] Symptomatology after pelvic surgery (Abdominoperineal Resection) with extensive dissection and post-op urinary incontinence […] Prolonged straining and difficulty passing stools.

• #15 Pudendal Neuralgia – Diagnosis & Treatment

  https://ainasc.com/conditions/pudendal-neuralgia/

  The pudendal nerve is the main nerve of the perineum. The perineum is the area between the testicles and anus of a man, and the vagina and anus of a woman. When this nerve suffers an injury, it can result in the most chronic and disabling form of pelvic pain, pudendal neuralgia. […] Although pudendal neuralgia has come to be used interchangeably with pudendal nerve entrapment and Alcock Canal Syndrome, a 2009 study found pudendal neuralgia to be a “rare event” and “no evidence to support equating the presence of this syndrome with a diagnosis of pudendal nerve entrapment.” This means one might display all the symptoms of pudendal neuralgia but not actually have an entrapped (pinched) pudendal nerve. Entrapment is just one possible cause. […] Infrequency, however, does not change the fact that pudendal neuralgia is a debilitating and extremely unpleasant condition. The agony can become so intense, individuals are unable to urinate, have intercourse, or even sit without experiencing intense, shooting, burning pain in the genitals and seat region.

• #16 Pudendal Nerve Block | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27998

  Pudendal nerve blocks are a preferred technique for diagnosing and managing chronic pelvic pain, particularly in cases of pudendal neuralgia often linked to nerve entrapment. […] The most common causes of pudendal neuralgia are repetitive activities and overuse of the pelvic floor muscles, typically microtrauma from prolonged sitting. Pudendal neuralgia can also be caused by repetitive sports activities, primarily cycling, motor vehicle accidents, falls, pelvic surgeries (especially pelvic prolapse procedures that utilize mesh), radiation therapy, ischial spinal fractures, benign and malignant tumors, and obstetrical injuries. […] Pudendal nerve blocks are also used to treat the pain associated with pudendal neuralgia and aid in its diagnosis. Patients describe the pudendal neuralgia pain as a burning sensation and hyperalgesia in the external genital and perineal region.

• #17 Pudendal neuralgia | American Hospital of Paris

  https://www.american-hospital.org/en/pathologie/pudendal-neuralgia

  The causes of pudendal neuralgia may differ from one person to the next. Nevertheless, the condition generally stems from irritation or compression of the pudendal nerve, which may be linked to the following risk factors: […] Pudendal neuralgia can also be caused by underlying medical issues such as diabetes, multiple sclerosis, Lymes disease, genital herpes or recurrent urinary infections. Onset often occurs between the ages of 50 and 70, and is more common in women (affecting 6 women for every 4 men). […] Cryoneurolysis uses extreme cold to deactivate the nerve fibers that are causing pain.

• #18 Groin Pain Etiology: Pudendal Neuralgia | Anesthesia Key

  https://aneskey.com/groin-pain-etiology-pudendal-neuralgia/

  Pudendal neuralgia is broadly defined. We define this as pain in the distribution of the pudendal nerve that can arise from a series of separate mechanisms. Pudendal nerve entrapment (PNE) is the direct result of pelvic trauma. Causes of trauma can include surgery, childbirth, bicycle seats, sex, or athletic activities. Pelvic surgery is among the more common causes of PNE today. […] Pudendal nerve entrapment is defined as compression of the pudendal nerve, typically by scar tissue or surgical material such as sutures or mesh products. The true prevalence of pudendal neuralgia is unknown. […] Pain that mimics pudendal nerve compression may be caused by pelvic floor muscle spasm. Since the pudendal nerves course through the pelvic floor muscles toward the surface of the skin, any muscle spasm that occurs in the pelvic floor can result in further compression of the nerve and severe pain. […] It is important to appreciate that this pain is neuropathic in nature and often accompanied by significant allodynia and hyperesthesia.

• #19 A musculoskeletal approach for patients with pudendal neuralgia: a cohort study – BJUI

  https://www.bjuinternational.com/case-studies/a-musculoskeletal-approach-for-patients-with-pudendal-neuralgia-a-cohort-study/

  Various musculoskeletal impairments have been associated with pudendal neuralgia, such as pelvic floor dysfunction, connective tissue restrictions, myofascial trigger points, muscle hypertonicity, altered neurodynamics, and structural and biomechanical abnormalities, such as lumbopelvic dysfunctions. […] Although it has been stated that the pudendal nerve can be significantly affected by abnormalities of the sacroiliac joint because innominate rotations may result in increased tension in the ligaments through which the pudendal nerve travels, there are many mechanisms that may have been influenced during our multimodal intervention.

• #20 Neuropelveological assessment of neuropathic pelvic pain | Gynecological Surgery | Full Text

  https://gynecolsurg.springeropen.com/articles/10.1007/s10397-014-0838-4

  In neurogenic PN damage, loss of sensation or numbness selectively is usually combined with contralateral anal deviation due to homolateral perineal/perianal myoatrophia. […] There are numerous possible causes for pudendal neuropathy. Some of the possible causes are an inflammatory or autoimmune illness, frequently interpreted as infection. […] After iatrogenic nerve damage, which are frequent in obstetrics and gynecology pudendal neuralgia is common, with etiologies such as compression of the nerve through a postpartum hematoma, fibrosis of the ischiorectal fossa, stretching of the nerve during delivery, or surgical damage during transvaginal sacrospinous colpopexy. […] Recent interventions using mesh material for sacrospinal fixation, sacrocolpopexy, or rectopexy may also expose patients to a risk of pudendal nerve damage.

• #21 Pudendal Nerve Decompression – Medical Clinical Policy Bulletins | Aetna

  https://www.aetna.com/cpb/medical/data/800_899/0805.html

  It is important to note that it does not have definite etiological implications, and there is no evidence to support equating the presence of this syndrome with a diagnosis of PNE although that may be one etiological condition. […] Proof of diagnosis rests on pain relief following local anesthetic nerve blocks or decompression of the nerve in Alcock’s canal, but long-term pain relief is rarely achieved. […] The authors concluded that this preliminary study suggested that complete disappearance of pain for at least 2 weeks after a nerve block repeated twice before surgery may be the best criterion to predict success. […] The authors concluded that PNE can be a cause of chronic, disabling perineal pain in both men and women. […] The authors concluded that PND provided relief and improvement in the sensory and motor manifestations of the pudendal nerve in 9/11 women. […] The authors concluded that LaPNDT seems a feasible surgical modality for cautiously selected patients with PNE. […] The authors concluded that PNN emerges as an effective treatment for PNE with minimal morbidity.

• #22 Advances in the therapeutic approach of pudendal neuralgia: a systematic review

  https://www.degruyterbrill.com/document/doi/10.1515/jom-2021-0119/html?lang=en&srsltid=AfmBOopHRhkm8zQNdOKt-FY6exg6qYyG-kpDg7qaKrCAZcp1d3rv3ZTh

  Raw examination of the included studies shows that surgery, with no preferential site, seems to be the most efficient therapeutic approach: pain is significantly relieved, sometimes even completely. In all articles dedicated to this type of treatment, the patients’ quality of life is reported as considerably improved, ensuring a return to optimal social life and overall health status. The most striking benefit of surgery is the duration of pain improvement, which varies from long-term (commonly 4 years) to permanent. Moreover, no serious postoperative complication was reported in any of the studies. In some cases, a second surgical intervention is required several months later to achieve complete recovery.

• #23 Neurogenic genital pain: Pudendal neuralgia and inferior hypogastric plexalgia – MSK Neurology

  https://mskneurology.com/neurogenic-genital-pain-pudendal-neuralgia-and-inferior-hypogastric-plexalgia/

  The hypogastric plexus anastomoses with the somatic root ganglia of the lumbosacral plexuses. […] Weakness of the psoas major results in restricted neural gliding through the myofascial of the psoas major muscle and consequent entrapment neuropathy. […] Patients with pudendal neuralgia may have uni- or bilateral symptoms, usually worse on one side. […] The pain may be localized in the penis or vagina, perineum, or rectum and medial buttock, on that side. […] Electrodiagnostic tests are almost always normal. […] Strengthening the piriformis and obturator muscles, and with this developing worsening of symptoms, also confirms the diagnosis. […] The patient will not just go into remission as such. They will gradually improve with diligence and persistence to the protocol. […] The way to resolve muscular dysfunction, at least in this scenario, is to train it, which causes mild inflammation, recovery, slight increase in work capacity, and then repeat the process until the dysfunction has been resolved.

• #24 Pudendal Nerve Entrapment/Neuropathy/Damage | Mayo Clinic Connect

  https://connect.mayoclinic.org/discussion/pudendal-nerve-entrapmentneuropathydamage/?pg=3

  I can certainly empathize with folks who have said that this condition is a 'lonely’ problem, both because it is more rare in the general population and there apparently is not much data for physicians to access. […] PNE is not „rare” from what I’ve researched. There are clinics all over the country that treat this condition. However, I would assume that any entrapped nerve could be treated in a similar manner. […] There are cures for entrapped nerves but you just have to find the source of entrapment. […] I suspect you just have myofascial pain in a region and it can be conquered. The Headache in the Pelvis authors point that out – everything in the hips and back is so tightly innervated together that often people have multiple problems that are related (i.e. back pain / hip pain / spasms / IBS, etc.). Those nerves are all connected. Free the nerves!

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