239 results on '"Pudendal nerve"'
Search Results
2. The Clinical Efficacy of High-Voltage Long-Duration Pulsed Radiofrequency Treatment in Pudendal Neuralgia: A Retrospective Study
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Tao Song and Cheng-Long Wang
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SF-36 ,Visual analogue scale ,Pudendal nerve ,Ischial spine ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Pudendal Neuralgia ,Retrospective Studies ,Pulsed radiofrequency ,business.industry ,Pudendal neuralgia ,Chronic pain ,General Medicine ,medicine.disease ,Ischial tuberosity ,Pulsed Radiofrequency Treatment ,Treatment Outcome ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Neurology ,Anesthesia ,Quality of Life ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
BACKGROUND Patients with pudendal neuralgia (PN) experience long-lasting chronic pain, hyperalgesia, and comorbid emotional disorders, such as depression and anxiety. Treatment via conventional pulsed radiofrequency (PRF) current carries a significantly high rate of failure. OBJECTIVE To determine the safety and clinical efficacy of high-voltage, long-duration PRF application to the pudendal nerve in patients with PN. STUDY DESIGN Observational retrospective design, self before-after controlled clinical trial. MATERIALS AND METHODS We analyzed the records of 70 patients of our hospital with diagnosed PN. Treatment consisted of PRF application to the pudendal nerve, using computed tomography guidance to target the pudendal nerve at the level of the ischial spine or ischial tuberosity of the affected side. PRF was applied with the following parameters: temperature 42°C, frequency 2 Hz, pulse width 20 ms, field intensity ramped gradually from 40 to 90 V, duration 900 sec. The therapeutic effect was evaluated by collecting patient scores for the visual analog scale (VAS), SF-36 health survey questionnaire (SF-36), and patient health questionnaire (PHQ-9) before treatment and at 1-, 4-, and 12-week follow-ups after PRF treatment. Data were analyzed by paired t-test with p
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- 2022
3. Innervation of the scrotum by the anterior division of the obturator nerve – a rare variation
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Satheesha B Nayak and S.K. Vasudeva
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Male ,endocrine system ,Ilioinguinal nerve ,endocrine system diseases ,urogenital system ,Genital branch of genitofemoral nerve ,business.industry ,Pudendal nerve ,Lumbosacral Plexus ,Anatomy ,Thigh ,urologic and male genital diseases ,Spermatic cord ,medicine.anatomical_structure ,Scrotum ,medicine ,Humans ,Sex organ ,Obturator nerve ,Obturator Nerve ,business - Abstract
Summary The scrotum is supplied by ilioinguinal, genital branch of genitofemoral, perineal branch of the posterior cutaneous nerve of the thigh and the posterior scrotal branches of the pudendal nerve. We report an extremely rare innervation of the anterior part of the scrotum by the anterior division of the right obturator nerve. The genital branch of genitofemoral nerve did not reach the scrotum. The ilioinguinal nerve did not supply the scrotum. The anterior division of the obturator nerve gave a branch which ascended superomedially in the thigh, crossed superficial to the spermatic cord and communicated with the right ilioinguinal nerve. As it crossed the spermatic cord, it gave a scrotal branch which descended over the spermatic cord and ramified to supply the anterior part of the scrotum. Knowledge of this variation could be important to anaesthesiologists, urologists and surgeons in general.
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- 2022
4. Short-term Efficacy and Mechanism of Electrical Pudendal Nerve Stimulation Versus Pelvic Floor Muscle Training Plus Transanal Electrical Stimulation in Treating Post-radical Prostatectomy Urinary Incontinence
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Siyou Wang, Jianwei Lv, Tingting Lv, Meixian Li, and Xiaoming Feng
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Male ,medicine.medical_specialty ,Urinary Incontinence, Stress ,Urology ,medicine.medical_treatment ,Pudendal nerve ,Stimulation ,Urinary incontinence ,Pelvic Floor Muscle ,law.invention ,Pudendal nerve stimulation ,Randomized controlled trial ,Quality of life ,law ,Humans ,Medicine ,Prostatectomy ,business.industry ,food and beverages ,Pelvic Floor ,Electric Stimulation ,Exercise Therapy ,Pudendal Nerve ,Treatment Outcome ,Urinary Incontinence ,Quality of Life ,Female ,medicine.symptom ,business - Abstract
To assess the short-term efficacy of electrical pudendal nerve stimulation (EPNS) versus pelvic floor muscle training (PFMT) plus transanal electrical stimulation (TES) for the early treatment of post-radical prostatectomy urinary incontinence (PRPUI) and explore its mechanism of action.A parallel designed randomized controlled trial was conducted at a research institute and a university hospital. Ninety-six PRPUI patients were allocated to EPNS group (64 cases) and PFMT+TES group (32 cases) and treated by EPNS and biofeedback-assisted PFMT plus TES, 3 times a week for 8 weeks, respectively. Outcome measurements were improvement rate, scores of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the number of used diapers.After 24 treatments, the efficacy rate of 68.7% in EPNS group was significantly higher than that of 34.4% in PFMT+TES group (P=0.005). The ICIQ-UI SF score, and urine leakage amount score, diaper score, symptom and quality of life improved significantly in both groups and showed Therapy x Treatment interaction, and the above scores in EPNS group were significantly lower than these in PFMT+TES group. Perineal ultrasonographic recordings showed that PFM movement amplitude during EPNS (≥1-3 mm) was similar to that during PFMT, however, PFM movement EMG amplitude was significantly higher during EPNS than during PFMT (P0.001).EPNS is more effective than PFMT+TES in short-term (8 weeks) treatments of early urinary incontinence after radical prostatectomy. Its mechanism of action is that EPNS can excite the pudendal nerve and simulate PFMT.
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- 2022
5. Regional anesthesia for ambulatory pediatric penoscrotal procedures
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Feroz Osmani, Natalie R. Barnett, and Fernando A. Ferrer
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Male ,medicine.medical_specialty ,medicine.drug_class ,Urology ,Pudendal nerve ,medicine.medical_treatment ,Anesthesia, Spinal ,Anesthesia, Conduction ,Humans ,Medicine ,Anesthetics, Local ,Child ,Past medical history ,business.industry ,Local anesthetic ,General surgery ,Nerve Block ,Pediatric urology ,Pudendal Nerve ,Pediatrics, Perinatology and Child Health ,Anesthetic ,Ambulatory ,Nerve block ,business ,Pediatric anesthesia ,medicine.drug - Abstract
Summary Background/Purpose Pediatric urology procedures are amongst the most commonly performed in children. The need for proactive treatment of pain is essential for optimal patient care. Current guidelines recommend the routine use of regional anesthesia in children as appropriate unless contraindicated. Given the commonality of urologic procedures in children, it is essential to understand the indications for and the utility of regional anesthesia. Methods The current literature was searched using PubMed as the primary platform. Search words included ‘dorsal penile nerve block,’ ‘pudendal nerve block,’ ‘ring block,’ ‘spinal anesthesia,’ and ‘caudal,’ along with ‘pediatric’, ‘circumcision,’ ‘hypospadias,’ ‘urology’, and ‘urological surgery’ as part of the keywords of the search. Results The articles resulting from the literature search were reviewed for content, clarity and study design by two co-authors, and agreement determined the incorporation into the review. Additionally, a detailed description of study design, regional anesthetic technique, local anesthetic(s) used, and outcomes of each study referenced was incorporated into the supplemental table. Conclusion Given the variance in block technique and local anesthetic choice amongst the current reported studies in the literature, it is difficult to truly compare and infer superiority of the regional anesthetic choices for ambulatory penoscrotal procedures. When choosing a regional anesthetic technique, careful consideration must be placed on block coverage, severity of expected pain and surgical duration of the procedure, type and dose of local anesthetic, as well as the patient’s past medical history and anatomy. Moreover, the regional block chosen should result from a thorough preoperative discussion between the surgeon and the anesthesiologist.
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- 2021
6. Diagnostic and therapeutic algorithm for pudendal nerve entrapment syndrome
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Inés Galé, María José Luesma, and José Fernando
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Anamnesis ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Visual analogue scale ,Pulsed radiofrequency ,Pudendal nerve ,Pudendal neuralgia ,Physical examination ,General Medicine ,medicine.disease ,Palpation ,Pudendal Nerve ,Pelvic floor dysfunction ,Humans ,Medicine ,Radiology ,business ,Algorithms ,Physical Therapy Modalities ,Pain Measurement ,Pudendal Neuralgia - Abstract
Pudendal nerve entrapment syndrome is widely unknown and often misdiagnosed or confused with other pelvic floor diseases. The aim is to develop a diagnostic and therapeutic algorithm based on a review of the existing literature. For its diagnosis, an anamnesis will be carried out in search of possible aetiologies, surgical history, and history of pain, assessing location and irradiation, intensity on the visual analogue scale, timing, triggering factors and rule out alarm signs. A physical examination will be performed, looking for trigger points or areas of fibrosis with transvaginal / transrectal palpation of the terminal branches of the nerve. With a doubtful diagnosis, an anaesthetic block of the pudendal nerve can be performed. Once the diagnosis is confirmed, the treatment will begin staggered with lifestyle changes, drug therapy and physiotherapy. In view of the failure of these measures, invasive therapies such as botulinum toxin injection, pulsed radiofrequency and decompression surgery or spinal cord stimulation will be used.
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- 2021
7. Excision of deep endometriosis nodules of the sciatic nerve using robotic assistance, with video
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Horace, Roman, Adrien, Crestani, and Benjamin, Merlot
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Robotic Surgical Procedures ,Endometriosis ,Humans ,Female ,Laparoscopy ,Obturator nerve ,Robotic surgery ,Sciatic nerve ,General Medicine ,Peritoneum ,Deep endometriosis ,Sciatic Nerve ,Pudendal nerve - Published
- 2022
8. A Novel Perineal Nerve Block Approach for Transperineal Prostate Biopsy: An Anatomical Analysis-based Randomized Single-blind Controlled Trial
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Guang-An Xiao, Peng Xi, Zhen Liu, Zhenkai Shi, Yi Liu, Bi-Ming He, Yi Zhou, Maoyu Wang, Chuanliang Xu, Hai-Feng Wang, Xu Gao, Heng-Zhi Lin, Xiaodan Guo, Hu-Sheng Li, Yinghao Sun, and Sheng Xia
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Male ,medicine.medical_specialty ,Visual analogue scale ,Biopsy ,Urology ,030232 urology & nephrology ,law.invention ,medicine.nerve ,03 medical and health sciences ,0302 clinical medicine ,Periprostatic ,Randomized controlled trial ,Cadaver ,law ,Humans ,Pain Management ,Medicine ,Single-Blind Method ,Local anesthesia ,Aged ,Pain Measurement ,medicine.diagnostic_test ,business.industry ,Biopsy, Needle ,Prostate ,Prostatic Neoplasms ,Nerve Block ,Middle Aged ,Pudendal Nerve ,Treatment Outcome ,Perineal nerve ,030220 oncology & carcinogenesis ,Prostate Capsule ,Radiology ,business ,Anesthesia, Local - Abstract
OBJECTIVE To develop and validate a novel perineal nerve block approach for transperineal prostate biopsy. PATIENTS AND METHODS Five adult male cadavers were dissected to delineate the superficial and deep branches of the perineal nerve. Afterwards, 90 out of 115 patients were selected and randomly assigned to receive periprostatic, periapical triangle, or branches of perineal nerve (BPN) block. The primary outcome was the maximal pain intensity associated with transperineal prostate biopsy, which was assessed by the 10-point visual analog scale. The secondary outcomes included the number of biopsy with visual analog scale of ≥4 in each biopsy procedure, and the incidences of complications. RESULTS On the horizontal line of the upper anal border, the locations of the superficial branch of perineal nerve on the left and right sides were 1.87 ± 0.05 cm and 1.86 ± 0.06 cm, respectively; and the deep branch were 2.15 ± 0.07 cm and 2.16 ± 0.06 cm, respectively, from the midline, and lied between the deep layer of superficial fascia and prostate capsule. The number of cases finally enrolled in data analysis in periprostatic block, periapical triangle block, and BPN block groups were 26, 27, and 30, respectively. The maximal pain intensities were 3.4 (3.1-3.7), 3.3 (3.0-3.6), and 1.8 (1.5-2.2) in the 3 groups, respectively, and the numbers of biopsy with the pain intensity of ≥4 were 4.0 (3.2-4.9), 4.2 (3.3-5.2), and 0.7 (0.1-1.2), respectively. There were 4, 3 and 4 cases developing hematuria, and 1, 1 and 2 burdened with urine retention after biopsy in the 3 groups, respectively. CONCLUSION Collectively, BPN block is a safe, effective and repeatable local anesthesia approach for transperineal prostate biopsy.
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- 2020
9. Pudendal Nerve Identified on Sectioned Images of Female Cadaveric Pelvis
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Min Suk Chung, Beom Sun Chung, and Byoung Jin Choi
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Adult ,Urology ,Pudendal nerve ,030232 urology & nephrology ,Pelvis ,03 medical and health sciences ,Pudendal canal ,Atlases as Topic ,0302 clinical medicine ,Cadaver ,medicine.artery ,Humans ,Medicine ,Internal pudendal artery ,Anatomy, Artistic ,Anatomy, Cross-Sectional ,business.industry ,Urogenital triangle ,Anatomy ,Sciatic Nerve ,Pudendal Nerve ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Dorsal nerve of clitoris ,Cadaveric spasm ,business - Abstract
Objective To provide an anatomical atlas made of serially sectioned images of a female cadaver that clearly demonstrated the pudendal nerve. Materials and Methods The courses of the pudendal nerve, internal pudendal artery, and internal pudendal vein were observed on the sectioned images of a female cadaver. The spatial relationship between the nerve and blood vessels was interpreted. Results Traces of the structures on the sectioned images showed that the sources of the sciatic and pudendal nerves were the fourth lumbar nerve to the second sacral nerve and the second to the fourth sacral nerves, respectively. As the borderline, the second sacral nerve showed a remarkable variation. The pudendal nerve gave off the internal rectal nerve proximal to the pudendal canal and it gave off the muscular branch to the urogenital triangle in the pudendal canal. It was divided into the posterior labial nerve and the dorsal nerve of clitoris distal to the pudendal canal. Inside the pudendal canal, the internal pudendal vein, internal pudendal artery, and pudendal nerve were arranged from superomedial to inferolateral order. In other words, the pudendal nerve was the farthest from the uterus. Conclusion The sorted sectioned images with labels, accompanied by the schematic drawings, could serve as references for interpreting clinical images and conducting procedures related to pudendal nerve conditions.
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- 2020
10. Poststimulation Block of Pudendal Nerve Conduction by High-Frequency (kHz) Biphasic Stimulation in Cats
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William C. de Groat, Bing Shen, Jicheng Wang, Changfeng Tai, James R. Roppolo, Haotian Cai, Zhaoxia Wang, and Natalie Pace
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Male ,Pudendal nerve ,Distal Urethra ,Neural Conduction ,Stimulation ,Article ,03 medical and health sciences ,0302 clinical medicine ,Urethra ,Block (telecommunications) ,Animals ,Medicine ,CATS ,business.industry ,Urethral sphincter ,Nerve Block ,General Medicine ,Electric Stimulation ,Pudendal Nerve ,Intensity (physics) ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Neurology ,Cats ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Biomedical engineering - Abstract
OBJECTIVE: To determine the relationship between various parameters of high-frequency biphasic stimulation (HFBS) and the recovery period of post-HFBS block of the pudendal nerve in cats. MATERIALS AND METHODS: A tripolar cuff electrode was implanted on the pudendal nerve to deliver HFBS in ten cats. Two hook electrodes were placed central or distal to the cuff electrode to stimulate the pudendal nerve and induce contractions of external urethral sphincter (EUS). A catheter was inserted toward the distal urethra to slowly perfuse the urethra and record the back-up pressure generated by EUS contractions. After determining the block threshold (T), HFBS (6 or 10 kHz) of different durations (1, 5, 10, 20, 30 min) and intensities (1T or 2T) was used to produce the post-HFBS block. RESULTS: HFBS at 10 kHz and 1T intensity must be applied for at least 30 min to induce post-HFBS block. However, 10 kHz HFBS at a higher intensity (2T) elicited post-HFBS block after stimulation of only 10 min; and 10 kHz HFBS at 2T for 30 min induced a longer-lasting (1–3 h) post-HFBS block that fully recovered with time. HFBS of 5-min duration at 6 kHz produced a longer period (20.4 ± 2.1 min, p < 0.05, N = 5 cats) of post-HFBS block than HFBS at 10 kHz (9.5 ± 2.1 min). CONCLUSION: HFBS of longer duration, higher intensity, and lower frequency can produce longer-lasting reversible post-HFBS block. This study is important for developing new methods to block nerve conduction by HFBS.
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- 2020
11. The effect of a new geometric bicycle saddle on the genital-perineal vascular perfusion of female cyclists
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N. Piazza, G. Breda, A. Paggiaro, and G. Cerri
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medicine.medical_specialty ,Pelvic floor ,business.industry ,Pudendal nerve ,Urogenital disorders ,Sitting ,Female Sexual Dysfunction ,Perineal compression ,Vulva ,medicine.anatomical_structure ,Vagina ,medicine ,Physical therapy ,Orthopedics and Sports Medicine ,Sex organ ,business ,Sexual function ,Saddle - Abstract
Summary Purpose Female cyclists undergo a perineal compression of the pudendal nerve and genital-perineal area, with underexplored effects on genital injuries and sexual dysfunctions. This study tests the effects of a new geometric bicycle saddle (SMP) on perineal compression, blood perfusion, genital sensation and sexual function. Methods Thirty-three professional female athletes were monitored when using both the new saddle and a traditional professional saddle, in a randomized order. Short-term effects are estimated by measuring the partial pressure of vagina transcutaneous oxygen (PtcO2) before using the saddle, after 10 minutes of static sitting, after riding 20 minutes. Long-term effects are estimated by measuring athletes Female Sexual Distress Scale (FSDS) before using the new saddle and after 6 months using it. Results From an initial average of 70 mmHg, PtcO2 decreases by 30 mmHg after riding on a traditional saddle, 10 mmHg on the new saddle (respectively 20 and 7 after just sitting). When using the traditional saddle all FSDS scores are well over the 12 “normality” threshold, with an average of 41, while after using the new saddle the average falls to 12. All differences between the saddles are strongly significant: paired t-tests > 6; P Conclusion Traditional saddles have strong negative effects on the vascular perfusion of the vulva, with possible consequences on female sexual functions. The SMP saddle reduces the compression on the pelvic floor and can help reducing the incidence of urogenital pathologies for female cyclists.
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- 2020
12. A Novel Approach to Managing Post Retropubic Vaginal Sling Pain
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Sarah Martin, Kenneth M. Peters, and Esther Han
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medicine.medical_specialty ,Sling (implant) ,Urinary Incontinence, Stress ,Urology ,Pudendal nerve ,030232 urology & nephrology ,Urinary incontinence ,Pelvic Pain ,Perineum ,Prosthesis Implantation ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,Retropubic space ,Device Removal ,Pudendal Neuralgia ,Suburethral Slings ,Pelvic floor ,business.industry ,Pelvic pain ,Chronic pain ,Trigger Points ,Middle Aged ,Surgical Mesh ,medicine.disease ,Symptomatic relief ,Pudendal Nerve ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Transcutaneous Electric Nerve Stimulation ,Female ,Chronic Pain ,medicine.symptom ,business - Abstract
Objective To describe a novel technique of using peripheral nerve neuromodulation (PNNM) for the treatment of refractory, mesh-induced chronic pelvic pain. Chronic pelvic pain associated with mesh can be a debilitating complication and there is currently no consensus on treatment. PNNM has been shown to be successful in the treatment of post-traumatic neuralgias but has yet to be studied in mesh complications. Materials and Methods We present a case of a 50-year-old woman who had unrelenting pelvic pain after retropubic sling placement. She failed multiple therapies including medications, mesh removal, pelvic floor physical therapy, pudendal neuromodulation, and pelvic floor onabotulinumtoxinA trigger point injections. Results The only treatment that provided temporary relief of this patient's pain was transvaginal trigger point injections along with a right pudendal nerve block using 40 mg triamcinolone and 0.5% ropivacaine. To help define if treatment at the site of her pain would provide relief, a series of blocks were done by advancing a needle retropubically to her area of pain and injecting triamcinolone and 0.5% ropivacaine. This injection, which corresponded to the previous tract of her retropubic sling, provided temporary, but profound, relief. PNNM was then done with placement of the electrode in the retropubic space at the site of her pain. This provided instantaneous relief of almost all of her pain symptoms. Twelve months postoperatively, the patient continued to have >90% improvement in her pain. Conclusion Focused PNNM is a simple procedure and can provide symptomatic relief for refractory postvaginal mesh pain.
- Published
- 2020
13. Robot-assisted Exploration of Somatic Nerves in the Pelvis and Transection of the Sacrospinous Ligament for Alcock Canal Syndrome
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Kiyoshi Kanno, Masaaki Andou, M. Sawada, Shiori Yanai, Kiyoshi Aiko, and Shintaro Sakate
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medicine.medical_specialty ,Pudendal nerve ,Pelvic Pain ,Pelvis ,Superior gluteal nerve ,medicine.nerve ,medicine.artery ,medicine.ligament ,Humans ,Medicine ,Neurolysis ,Ligaments ,business.industry ,Sacrospinous ligament ,Obstetrics and Gynecology ,External iliac artery ,Robotics ,Middle Aged ,Pudendal Nerve ,Surgery ,body regions ,medicine.anatomical_structure ,Inferior gluteal nerve ,Female ,Laparoscopy ,business ,Lumbosacral joint - Abstract
Study Objective Some articles have reported the surgical management of Alcock canal syndrome (ACS) using the transperineal [1] , transgluteal [2] , or conventional laparoscopic approach [ 3 , 4 ]. In 2015, Rey and Oderda [5] reported the first robotic neurolysis of the pudendum, providing the advantages of robot-assisted surgery: magnified and 3-dimensional vision and greater precision of movements. However, to our knowledge, there have been no reports on the use of a robotic platform for the treatment of ACS in the field of gynecology. Therefore, the objective of this video is to describe the anatomic and technical highlights of robotic exploration of the somatic nerves in the pelvis and transection of the sacrospinous ligament (nerve decompression) for ACS. Design Stepwise demonstration of the technique with narrated video footage. Setting An urban general hospital. A 48-year-old woman who had no previous surgical history was referred for severe pain when sitting, cyclic pelvic pain, and gluteal and perineal pain, all of which were resistant to medication therapy. Her pain radiated to the posterior aspect of the thigh. Before coming to our hospital, she visited an orthopedic surgeon a few years earlier and was diagnosed with sciatic neuralgia. Magnetic resonance imaging revealed adenomyosis with neither deep endometriosis nor vascular entrapment. On the basis of neuropelveologic evaluation, the patient was suspected to be suffering from ACS owing to compression of the pudendal nerve and the posterior cutaneous nerve of the thigh by the sacrospinous ligament. Interventions The procedure was performed using the following 9 steps while referencing the laparoscopic neuronavigation technique [6] : step 1, opening the peritoneum along the external iliac artery; step 2, exposure of the external iliac artery; step 3, development of the lumbosacral space; step 4, identification of the lumbosacral trunk; step 5, identification of the superior gluteal nerve; step 6, identification of the sciatic nerve; step 7, identification of the inferior gluteal nerve; step 8, identification of the pudendal nerve; and step 9, transection of the sacrospinous ligament. The surgery was completed successfully without any complications, and the postoperative course was uneventful. We considered that there was no relationship between the ACS and endometriosis. The patient reported that her pain decreased gradually at postoperative month 1 and month 3, and finally the neuralgia was completely resolved at month 6. Neuropelveologic evaluation still continues every 6 months. Conclusion Robot-assisted transection of the sacrospinous ligament is a feasible, safe technique for selected patients with ACS. Exploration of the pelvic nerves should be performed for further diagnosis and therapy before prematurely labeling the patient as refractory to the treatment [7] .
- Published
- 2022
14. Pudendal Nerve Blocks: An Introduction and How-to Guide
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E.T. Carey, A.B. McClurg, and J. Wong
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business.industry ,Pudendal nerve ,Obstetrics and Gynecology ,Medicine ,Anatomy ,business - Published
- 2021
15. Effectiveness of two different acupuncture strategies in patients with vulvodynia: Study protocol for a pilot pragmatic controlled trial
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Sudaba Rahimi, Sarah Faggert Alemi, Hui Ouyang, Guanhu Yang, Hui Wei, Arthur Yin Fan, Changzhen Gong, Haihe Tian, Yingping H. Zhu, Deguang He, and Chong He
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Adult ,medicine.medical_specialty ,Adolescent ,Vulvodynia ,Pudendal nerve ,Acupuncture Therapy ,Pilot Projects ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Clinical Protocols ,Randomized controlled trial ,law ,Muscle tension ,Acupuncture ,Humans ,Medicine ,Acupuncture Analgesia ,Pain Measurement ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,030205 complementary & alternative medicine ,Clinical trial ,Research Design ,Ashi ,Physical therapy ,Female ,Integrative medicine ,business ,030217 neurology & neurosurgery - Abstract
Background Vulvodynia, or vulvar pain, is a common condition in women; however, there are few evidence-based clinical trials evaluating nonpharmacological therapies for this condition. Acupuncture is one complementary and integrative medicine therapy used by some patients with vulvodynia. This study evaluates two different acupuncture strategies for the treatment of vulvodynia and aims to evaluate whether either of the acupuncture protocols reduces vulvar pain, pain duration or pain with intercourse. The study also examines how long the effect of acupuncture lasts in women with vulvodynia. Methods/design The study is designed as a randomized controlled trial, focused on two acupuncture protocols. Fifty-one patients who have had vulvodynia for more than 3 months will be recruited. Among them, 34 patients will be randomized into Groups 1a and 1b; those who are unwilling to receive acupuncture will be recruited into the standard care group (Group 2). Patients in Group 1a will have acupuncture focused on the points in the pudendal nerve distribution area, while patients in Group 1b will receive acupuncture focused on traditional (distal) meridian points. Patients in Group 2 will receive routine conventional treatments, such as using pain medications, local injections and physical therapies or other nonsurgical procedures. Acupuncture will last 45 min per session, once or twice a week for 6 weeks. The primary outcome measurement will be objective pain intensity, using the cotton swab test. The secondary outcome measurement will be subjective patient self-reported pain intensity, which will be conducted before cotton swab test. Pain intensities will be measured by an 11-point Numeric Pain Rating Scale. Pain duration and pain score during intercourse are recorded. Local muscle tension, tenderness and trigger points (Ashi points) are also recorded. All measurements will be recorded at baseline (before the treatment), at the end of each week during treatment and at the end of the 6 weeks. Follow-up will be done 6 weeks following the last treatment. Discussion Results of this trial will provide preliminary data on whether acupuncture provides better outcomes than nonacupuncture treatments, i.e., standard care, and whether acupuncture focused on the points in pudendal nerve distribution, near the pain area, has better results than traditional acupuncture focused on distal meridian points for vulvodynia. Trial Registration: Clinicaltrials.gov: NCT03481621. Register: March 29, 2018.
- Published
- 2018
16. Spinal mechanisms of pudendal nerve stimulation-induced inhibition of bladder hypersensitivity in rats
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Buffie Clodfelder-Miller, Xin Su, Jamie McNaught, Timothy J. Ness, and Cary DeWitte
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Urinary Bladder ,030232 urology & nephrology ,Methysergide ,Pain ,Stimulation ,Piperazines ,Article ,Rats, Sprague-Dawley ,03 medical and health sciences ,0302 clinical medicine ,Phentolamine ,Cyclohexanes ,Neuromodulation ,Reflex ,medicine ,Animals ,Bladder Pain ,Urinary bladder ,Naloxone ,business.industry ,General Neuroscience ,Bicuculline ,Electric Stimulation ,Pudendal Nerve ,medicine.anatomical_structure ,Nociception ,Spinal Cord ,Anesthesia ,Female ,business ,030217 neurology & neurosurgery ,Muscle Contraction ,medicine.drug - Abstract
Bilateral electrical pudendal nerve stimulation (bPNS) reduces bladder hypersensitivity in rat models of bladder pain and anecdotally reduces pain in humans with pelvic pain of urologic origin. The spinal neurochemical mechanisms of this antinociception are unknown. In the present study, bladder hypersensitivity was produced by neonatal bladder inflammation in rat pups coupled with a second inflammatory insult as an adult. Visceromotor responses (VMRs; abdominal muscle contractions) to urinary bladder distension (UBD) were used as a nociceptive endpoint under urethane-isoflurane anesthesia. bPNS consisted of bilateral biphasic electrical stimulation of the mixed motor/sensory component of the pudendal nerves. Following determination of the inhibitory effect of bPNS on VMRs, pharmacological antagonists were administered via an intrathecal catheter onto the lumbosacral spinal cord and bPNS effects on VMRs redetermined. bPNS resulted in statistically significant inhibition of VMRs to UBD in hypersensitive rats that was statistically reduced by the intrathecal administration of methysergide, WAY100636, CGP35348 and strychnine but was unaffected by naloxone, bicuculline, phentolamine, ondansetron and normal saline. This study suggests that inhibitory effects of bPNS may include serotonergic, GABA-B-ergic and glycinergic mechanisms suggesting the potential for interaction of the neuromodulatory effect with concommitant drug therapies.
- Published
- 2018
17. Spinal interneuronal mechanisms underlying pudendal and tibial neuromodulation of bladder function in cats
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William C. de Groat, Haotian Cai, Jicheng Wang, James R. Roppolo, Shun Li, Changfeng Tai, Yan Zhang, Todd Yecies, and Bing Shen
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Male ,0301 basic medicine ,Spinal neuron ,Urinary Bladder ,Tibial nerve stimulation ,Article ,03 medical and health sciences ,0302 clinical medicine ,Developmental Neuroscience ,Interneurons ,Animals ,Medicine ,CATS ,BLADDER DISTENTION ,business.industry ,Anatomy ,Spinal cord ,Neuromodulation (medicine) ,Pudendal Nerve ,030104 developmental biology ,medicine.anatomical_structure ,Spinal Cord ,Neurology ,Cats ,Female ,Neuron ,Tibial Nerve ,business ,Bladder function ,030217 neurology & neurosurgery - Abstract
This study examined the mechanisms underlying pudendal and tibial neuromodulation of bladder function at the single neuron level in the spinal cord. A microelectrode was inserted into the S2 spinal cord of anesthetized cats to record single neuron activity induced by bladder distention over a range of constant intravesical pressures (10–40 cmH(2)O). Pudendal nerve stimulation (PNS) or tibial nerve stimulation (TNS) was applied at 5 Hz frequency and 0.2 ms pulse width and at multiples of the threshold (T) intensities for inducing anal or toe twitches. A total of 14 spinal neurons from 11 cats were investigated. Both PNS and TNS at 2 T intensity significantly (p < .05) reduced by 40–50% the frequency of firing induced by bladder distention at 20–40 cmH(2)O in the same spinal neurons. This reduction was not changed by blocking opioid receptors with naloxone (1 mg/kg, i.v.). Activation of pudendal afferents by repeatedly stroking (3–5 times per second) the genital skin using a cotton swab also inhibited the neuron activity induced by bladder distention. Prolonged (30 min) TNS at 4 T intensity produced a short lasting (10–18 min) post-stimulation inhibition that reduced by 40–50% bladder-related neuron activity at different bladder pressures. These results indicate that PNS and TNS inhibition of reflex bladder activity may be mediated in part by convergence of inhibitory inputs onto the same population of bladder-related interneurons in laminae V-VII of the S2 spinal cord and that an opioid receptor mechanism is not involved in the inhibition.
- Published
- 2018
18. Laparoscopic transperitoneal pudendal nerve and artery release for pudendal entrapment syndrome
- Author
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Julien Sarkis, Elie Nemr, J. Abi Chebel, A. Kallas Chemaly, Albert Semaan, Fabienne Absil, Georges Mjaess, Renaud Bollens, and Fouad Aoun
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Urology ,Pudendal nerve ,medicine ,business ,Entrapment syndrome ,Surgery ,Artery - Published
- 2021
19. Anorectal Transplantation: The First Long-Term Success in a Canine Model
- Author
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Jun Araki, Tomoyuki Sato, Masahiro Nakagawa, Yuji Nishizawa, Tomiko Yakura, Flávio Henrique Ferreira Galvão, Masatoshi Kamata, Shuichi Hirai, Naoki Fujita, Kensuke Tashiro, Tatsuo Nakamura, Munekazu Naito, Tomoya Iizuka, and Naoyuki Hatayama
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Electromyography ,Manometry ,business.industry ,medicine.medical_treatment ,Pudendal nerve ,Anastomosis, Surgical ,Anorectal manometry ,Rectum ,Colostomy ,Anal Canal ,Immunosuppression ,Anastomosis ,Surgery ,Transplantation ,Dogs ,medicine ,Animals ,Humans ,Defecography ,business ,Allotransplantation - Abstract
Background: Anorectal transplantation is a challenging procedure but a promising option for patients with weakened or completely absent anorectal function. We constructed a canine model of anorectal transplantation, evaluated the long-term outcomes, and controlled rejection and infection in allotransplantation. Methods: In the pudendal nerve function study, six dogs were randomly divided into two groups: transection and anastomosis, and were compared with a control using anorectal manometry, electromyography, and histological examination of the anorectal segment. In the anorectal transplantation model, four dogs were assigned to four groups: autotransplant, allotransplant with immunosuppression, allotransplant without immunosuppression, and normal control. Long-term function was evaluated by defecography, videography, and histological examination of the graft. Findings: In the pudendal nerve function study, anorectal manometry indicated that the anastomosis group recovered partial function 6 months postoperatively, but the resection group never regained function. Microscopically, the pudendal nerve and the sphincter muscle regenerated, and function was well-maintained in the anastomosis group at the end of the study. Anorectal transplantation was technically successful with a three-stage operation: colostomy preparation, anorectal transplantation, and stoma closure. The dog who underwent allotransplantation and immunosuppression had two episodes of mild rejection, which were reversed with methylprednisolone and tacrolimus. The dog who underwent allotransplantation without immunosuppression had a severe acute rejection that resulted in graft necrosis. Successful dogs had full defecation control at the end of the study. Interpretation: We described the first long-term success with anorectal transplantation in a canine model. This report is a proof-of-concept study for anorectal transplantation as a treatment for patients with an ostomy because of anorectal dysfunction. Funding Statement: This study was funded by a Japanese Society of Gastroenterology (JSPS) Fellows Grant (number: 201600159), and a JSPS KAKENHI Grant (number: JP 19K18075). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: All animal experiments were approved by the Animal Experimental Committee of Kyoto University and the University of Tokyo Animal Care and use Committee.
- Published
- 2020
20. Acupotomy combined with fire needle for sacral nerve dysfunction syndrome:A randomized, single-blind clinical trial
- Author
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Cai-rong Zhang, Wei Zhang, Min Yang, Zhi-zhong Ruan, and Xue-ping Zheng
- Subjects
Abdominal pain ,business.industry ,Pudendal nerve ,Abdominal distension ,Distension ,Clinical trial ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Complementary and alternative medicine ,Anesthesia ,Sacral nerve ,Medicine ,Defecation ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Objective: To provide the clinical evidence to evaluate the feasibility and refine the protocol for acupotomy combined with fire needle and pudendal nerve block therapy in treatment of sacral nerve dysfunction syndrome(SNDS). Methods: Seventy-five patients with SNDS were randomized into the treatment group (acupotomy and fire needle and pudendal nerve block therapy) and the control group (pudendal nerve block therapy). After a course of treatment, Visual Analogue Scales (VAS) of anorectal pain, defecation disorders, anal incontinence, VAS of lumbar pain or soreness, VAS of abdominal distension and pain were compared before and after the treatment. Result: Scores of defecation disorders, including defecation interval time index, defecation time index, fecal property index and defecation difficulty index, of patients with SNDS in the two groups were statistically different before and after the treatment in the same group (all P 0.05) after the treatment,. Scores of anal incontinence, VAS scores of lumbar pain or soreness, VAS scores of abdominal pain and distension in the two groups were statistically different before and after the treatment (all P 0.05). VAS scores of anorectal pain in the two groups were statistically different before and after the treatment (both P 0.05). Conclusion: In treating SNDS, acupotomy combined with fire needle and pudendal nerve block therapy can more effectively alleviate anorectal pain and improve the total effective rate.
- Published
- 2018
21. Comparison of Intraoperative and Early Postoperative Outcomes of Caudal vs Dorsal Penile Nerve Blocks for Outpatient Penile Surgeries
- Author
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Elizabeth A. S. Moser, Martin Kaefer, Konrad M. Szymanski, Richard C. Rink, Rosalia Misseri, Katherine H. Chan, Aali Shah, Mark P. Cain, and Benjamin Whittam
- Subjects
medicine.medical_specialty ,biology ,business.industry ,Urology ,medicine.medical_treatment ,Pudendal nerve ,Retrospective cohort study ,Ambulatory Surgical Procedure ,biology.organism_classification ,Confidence interval ,Pacu ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Anesthesia ,Nerve block ,medicine ,030212 general & internal medicine ,Intraoperative Period ,business ,Cohort study - Abstract
Objective To compare intraoperative and 1-hour postoperative outcomes in caudal vs dorsal penile nerve block (DPNB) patients undergoing penile surgeries. Materials and Methods We performed a retrospective cohort study of boys 3. Secondary outcomes were intraoperative-postanesthesia care unit (PACU) narcotics, preincision anesthesia time, adjusted operating room charges, and complications. We performed bivariate and multivariable analyses controlling for demographic and procedural characteristics and clustering by surgeon. Results Of 738 patients (mean age 2.1 years), 74.1% had a caudal block. DPNB patients were more likely to have a maximum pain score of >3 (19.5% vs 8.1%, P 3 (95% confidence interval 1.7-4.4, P Conclusion Caudal blocks may offer a small advantage in the immediate postoperative period, although cost-effectiveness is unproven.
- Published
- 2018
22. Anatomy of the Pudendal Nerve and Other Neural Structures Around the Proximal Hamstring Origin in Males
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Shane J. Nho, Bryan M. Saltzman, Rachel M. Frank, Nikhil N. Verma, Gift Ukwuani, Gregory L. Cvetanovich, and Charles A. Bush-Joseph
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Male ,Pudendal nerve ,Hamstring Muscles ,03 medical and health sciences ,0302 clinical medicine ,Cadaver ,Sacrotuberous ligament ,medicine.ligament ,medicine ,Humans ,Orthopedics and Sports Medicine ,Muscle, Skeletal ,Aged ,030222 orthopedics ,business.industry ,Dissection ,030229 sport sciences ,Anatomy ,Middle Aged ,Sciatic Nerve ,Pudendal Nerve ,Thigh ,Ligaments, Articular ,Sciatic nerve ,Piriformis muscle ,Cadaveric spasm ,business ,Hamstring - Abstract
Purpose To define the anatomy of the pudendal nerve in relationship to the proximal hamstring and other nearby neurological structures during proximal hamstring repair. Methods Six fresh-frozen human cadaveric hemi-pelvises from male patients ages 64.0 ± 4.1 years were dissected in prone position with hips in 10° flexion to identify the relationship of proximal hamstring origin to surrounding neurologic structures including the pudendal nerve, sciatic nerve, and posterior femoral cutaneous nerve. Two independent observers used digital calipers to measure distances. Results The pudendal nerve emerged at the inferior border of the piriformis muscle 6.3 ± 1.4 cm from the superior aspect of the proximal hamstring origin. It passed the superior border of the sacrotuberous ligament 3.0 ± 0.6 cm from the superior aspect and 3.9 ± 0.7 cm from the medial aspect of the hamstring origin. It crossed the inferior border of the sacrotuberous ligament 3.0 ± 0.4 cm from the superior aspect and 2.7 ± 0.7 cm from the medial aspect of the proximal hamstring origin. The shortest distance from the hamstring origin to the pudendal nerve was 2.6 ± 0.5 cm from the superior aspect and 2.3 ± 0.8 cm from the medial aspect. The shortest distance from the hamstring origin to the pudendal nerve was located deep to the sacrotuberous ligament in all cadavers. The sciatic nerve was an average of 1.1 ± 0.1 cm lateral to the lateral aspect of the proximal hamstring origin. The posterior femoral cutaneous nerve was located between the hamstring origin and the sciatic nerve, 0.7 ± 0.2 cm lateral to the lateral aspect of the proximal hamstring origin. Conclusions The proximal hamstring origin lies in close proximity to surrounding nerves, including the pudendal, sciatic, and posterior femoral cutaneous nerves. Clinical Relevance Knowledge that the pudendal nerve lies 2 to 3 cm superior and medial to the proximal hamstring origin may help to prevent iatrogenic damage during surgical dissection and retraction when performing proximal hamstring repair or deep gluteal space endoscopy.
- Published
- 2018
23. Physical Examination for Men and Women With Urologic Chronic Pelvic Pain Syndrome: A MAPP (Multidisciplinary Approach to the Study of Chronic Pelvic Pain) Network Study
- Author
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Claire C. Yang, Adam Omidpanah, John N. Krieger, and Jane L. Miller
- Subjects
Adult ,Male ,medicine.medical_specialty ,Cross-sectional study ,Urology ,030232 urology & nephrology ,Physical examination ,Pelvic Pain ,Pelvic Floor Disorders ,Palpation ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Cystitis ,medicine ,Chronic fatigue syndrome ,Humans ,Physical Examination ,Fatigue Syndrome, Chronic ,030219 obstetrics & reproductive medicine ,Pelvic floor ,Anthropometry ,Reflex, Abnormal ,medicine.diagnostic_test ,Genitourinary system ,business.industry ,Pelvic pain ,Middle Aged ,medicine.disease ,Prostatitis ,Pudendal Nerve ,Cross-Sectional Studies ,medicine.anatomical_structure ,Feasibility Studies ,Female ,Chronic Pain ,medicine.symptom ,business ,Algorithms ,Posterior superior iliac spine - Abstract
Objective To examine the feasibility of implementing a standardized, clinically relevant genitourinary examination for both men and women, and to identify physical examination findings characteristic of urologic chronic pelvic pain syndrome (UCPPS). Materials and Methods This study analyzed 2 samples: men and women with UCPPS who participated in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network Epidemiology and Phenotyping (EP) Study, and age-matched controls who were either positive for chronic fatigue syndrome or healthy (pain-free). We compared physical examination findings in both positive and healthy controls with UCPPS cases: findings from both the EP examinations and from an extended genitourinary examination. Results EP and extended examinations were performed on 143 participants: 62 UCPPS cases (30 women, 32 men), 42 positive controls (15 women, 27 men), and 39 healthy controls (22 women, 17 men). EP examinations showed that pelvic floor tenderness was more prevalent in cases (55.0%) than in positive (14.6%) or healthy controls (10.5%). Extended examinations revealed specific areas of tenderness in the pelvic floor musculature. Cases were also more likely than healthy controls to report tenderness in multiple areas, including suprapubic, symphysis pubis, and posterior superior iliac spine, and on bimanual examination. No comparative findings were specific to biological sex, and no evidence of pudendal neuropathy was observed on extended examination of cases or controls. Conclusion The extended genitourinary examination is an easily administered addition to the assessment of men and women during evaluation for UCPPS. Physical findings may help to better categorize patients with UCPPS into clinically relevant subgroups for optimal treatment.
- Published
- 2018
24. Robot-assisted pudendal neurolysis in the treatment of pudendal nerve entrapment syndrome
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P. Moscatiello, D. Carracedo-Calvo, A. Mendiola de la Hoza, M. Sánchez-Encinas, L. Yupanqui-Guerra, and M.E. Rivera-Martínez
- Subjects
medicine.medical_specialty ,Pudendal Nerve Entrapment Syndrome ,business.industry ,Decompression ,Visual analogue scale ,Pudendal nerve ,030232 urology & nephrology ,General Medicine ,Surgery ,03 medical and health sciences ,Dissection ,0302 clinical medicine ,Neuropathic pain ,Medicine ,030212 general & internal medicine ,business ,Neurolysis ,Intraoperative neurophysiological monitoring - Abstract
Introduction Pudendal 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 methods We 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. Results The procedure was performed satisfactorily without complications. After 24 h, 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. Conclusions Robot-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.
- Published
- 2018
25. Ultrasound-guided Pudendal Block Is a Viable Alternative to Caudal Block for Hypospadias Surgery: A Single-Surgeon Pilot Study
- Author
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Aaron Bayne, Jorge Piñeda, and Sarah Hecht
- Subjects
Male ,medicine.medical_specialty ,Urology ,Pudendal nerve ,Analgesic ,030232 urology & nephrology ,Pilot Projects ,Statistics, Nonparametric ,Fentanyl ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Anesthesia, Conduction ,030202 anesthesiology ,medicine ,Humans ,Pain Measurement ,Hypospadias ,Pain, Postoperative ,Urinary retention ,business.industry ,Infant ,Nerve Block ,Ultrasonography, Doppler ,Perioperative ,Length of Stay ,Hospitals, Pediatric ,medicine.disease ,United States ,Pudendal Nerve ,Surgery ,Treatment Outcome ,Surgery, Computer-Assisted ,Child, Preschool ,Anesthesia ,Cohort ,medicine.symptom ,business ,Follow-Up Studies ,medicine.drug ,Cohort study - Abstract
Objective To evaluate pudendal nerve block as an alternative to caudal block for hypospadias surgery. Methods Data were obtained by chart review. Children who underwent hypospadias repair between 2012 and 2016 by a single surgeon at an academic institution were included. Patients received ultrasound-guided pudendal block (n = 21) or caudal block (n = 19) as a regional adjunct to general anesthesia. Primary outcomes included analgesic requirement and postoperative length of stay in the recovery unit. Results The pudendal block cohort was slightly older (27.6 vs 18.5 months, P = .017) and had more severe hypospadias than the caudal block cohort (53% vs 35% proximal hypospadias, respectively). We detected no statistically significant difference in intraoperative opioid, postoperative opioid, or nonopioid analgesic requirement (17.9 vs 12.9 mcg fentanyl, P = .267; 0.3 vs 0.3 doses, P = .92; 0.2 vs 0.1 doses, P = .46, respectively). Postoperative length of stay was significantly shorter in the pudendal block cohort (96 vs 128 minutes, P = .016). Discussion We are the first to report the use of ultrasound-guided pudendal block for hypospadias repair. This appears to be a safe and effective alternative to caudal block with no perioperative delays. Pudendal block has several advantages over caudal block. It avoids the risks of urinary retention and lower extremity weakness and can be administered to older patients and children with spinal anomalies. Conclusion Compared with caudal block, ultrasound-guided pudendal nerve block is safe, provides equivalent pain control for hypospadias repair, and results in a shorter time to discharge.
- Published
- 2018
26. Low pressure voiding induced by stimulation and 1 kHz post-stimulation block of the pudendal nerves in cats
- Author
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Jianan Jian, William C. de Groat, Changfeng Tai, Jialiang Chen, Zhijun Shen, William Wang, Jonathan M. Beckel, Christopher Chermansky, Jicheng Wang, and Bing Shen
- Subjects
Male ,Pudendal nerve ,Urinary Bladder ,Distal Urethra ,Urination ,Stimulation ,Developmental Neuroscience ,Pressure ,Animals ,Medicine ,Spinal cord injury ,CATS ,business.industry ,Urethral sphincter ,medicine.disease ,Electric Stimulation ,Pudendal Nerve ,Catheter ,Urethra ,medicine.anatomical_structure ,Neurology ,Anesthesia ,Cats ,Female ,business ,Autonomic Nerve Block - Abstract
The goal of this study is to induce low-pressure voiding by stimulation and bilateral 1 kHz post-stimulation block of the pudendal nerves. In anesthetized cats, wire hook electrodes were placed on the left and/or right pudendal nerves. Stimulus pulses (30 Hz, 0.2 ms) were applied to one pudendal nerve to induce a reflex bladder contraction and to produce contractions of the external urethral sphincter (EUS). High frequency (1 kHz) biphasic stimulation was applied to block axonal conduction in both pudendal nerves and block EUS activity. In 4 cats, a catheter was inserted into the distal urethra to perfuse and measure the back pressure caused by the EUS contraction. In another 5 cats, a catheter was inserted into the bladder dome and the urethra was left open to allow voiding. The 1 kHz stimulation (30–60 s, 0.5–5 mA) delivered via a wire hook electrode completely blocked pudendal nerve conduction for ≥2 min after terminating the stimulation, i.e., a post-stimulation block. The block gradually disappeared in 6–18 min. The block duration increased with increasing amplitude or duration of the 1 kHz stimulation. Without the 1 kHz block, 30 Hz stimulation alone induced high-pressure (90 cmH2O) voiding. When combined with the 1 kHz block, the 30 Hz stimulation induced low-pressure (≤50 cmH2O) voiding with a high voiding efficiency (80%). In summary, a minimally invasive surgical approach might be developed to restore voiding function after spinal cord injury by stimulation and block of the pudendal nerves using lead electrodes.
- Published
- 2021
27. Postoperative pain after clitoral reconstruction in women with female genital mutilation: An evaluation of practices
- Author
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Barbara Maraux, Ghada Hatem-Gantzer, Marly Bah, Martin Caillet, Consuela Tataru, and Jasmine Abdulcadir
- Subjects
Adult ,Canada ,medicine.medical_specialty ,Pudendal nerve ,Analgesic ,Clitoris ,Computer-assisted web interviewing ,Belgium ,Germany ,Surveys and Questionnaires ,Burkina Faso ,medicine ,Acupuncture ,Humans ,Sex organ ,Dosing ,Netherlands ,Sweden ,Pain, Postoperative ,business.industry ,General surgery ,Obstetrics and Gynecology ,Nerve Block ,Plastic Surgery Procedures ,Senegal ,United States ,Pudendal Nerve ,Cote d'Ivoire ,medicine.anatomical_structure ,Reproductive Medicine ,Spain ,Austria ,Circumcision, Female ,Practice Guidelines as Topic ,Neuropathic pain ,Egypt ,Female ,France ,business ,Switzerland - Abstract
Introduction More than 200 million women and girls have undergone genital mutilation. Clitoral reconstruction (CR) can improve the quality of life of some of them, but is accompanied by significant postoperative pain. Objective Assess and describe the management of postoperative pain after CR, and the practices amongst specialists in different countries. Methods: Between March and June 2020, 32 surgeons in 14 countries (Germany, Austria, Belgium, Burkina Faso, Canada, Ivory Coast, Egypt, Spain, United States of America, France, the Netherlands, Senegal, Switzerland, Sweden) responded to an online questionnaire on care and analgesic protocols for CR surgery. Results At day 7 post CR, 97% of the surgeons observed pain amongst their patients, which persisted up to 1 month for half of them. 22% of the participants reported feeling powerless in the management of such pain. The analgesic treatments offered are mainly step II and anti-inflammatory drugs (61%). Screening for neuropathic pain is rare (3%), as is the use of pudendal nerve block, used by 8% of the care providers and only for a small percentage of women. Conclusion Pain after CR is frequent, long-lasting, and potentially an obstacle for the women who are willing to undergo clitoral surgery and also their surgeons. Most surgeons from different countries follow analgesic protocols that do not use the full available therapeutic possibilities. Early treatment of neuropathic pain, optimisation of dosing of standard analgesics, addition of opioids, use of acupuncture, and routine intraoperative use of pudendal nerve block might improve the management of pain after CR.
- Published
- 2021
28. Preoperative pudendal block with liposomal and plain bupivacaine reduces pain associated with posterior colporrhaphy: a double-blinded, randomized controlled trial
- Author
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Katherine L. Dengler, Angela DiCarlo-Meacham, Daniel D. Gruber, Christine M. Vaccaro, Eric R. Craig, Daniel I. Brooks, and Eva K. Welch
- Subjects
Bupivacaine ,Visual analogue scale ,Local anesthetic ,medicine.drug_class ,business.industry ,Pudendal nerve ,Analgesic ,Ischial spine ,Obstetrics and Gynecology ,Liposomal Bupivacaine ,medicine.anatomical_structure ,Anesthesia ,Vaginal Pain ,medicine ,business ,medicine.drug - Abstract
Background Pelvic reconstructive surgery may cause significant postoperative pain, especially with posterior colporrhaphy, contributing to a longer hospital stay and increased pain medication utilization. Regional blocks are being increasingly utilized in gynecologic surgery to improve postoperative pain and decrease opioid usage, yet preoperative pudendal blocks have not been used routinely during posterior colporrhaphy. Objective This study aimed to compare the effect of preoperative regional pudendal nerve block using a combination of 1.3% liposomal and 0.25% plain bupivacaine vs 0.25% plain bupivacaine alone on vaginal pain after posterior colporrhaphy on postoperative days 1, 2, and 3. We hypothesized that there would be a reduction in vaginal pain scores for the study group vs the control group over the first 72 hours. Study Design This was a double-blinded, randomized controlled trial that included patients undergoing a posterior colporrhaphy, either independently or in conjunction with other vaginal or abdominal reconstructive procedures. Patients were block randomized to receive 20 mL of either a combination of 1.3% liposomal and 0.25% plain bupivacaine (study) or 20 mL of 0.25% plain bupivacaine (control) in a regional pudendal block before the start of surgery. Double blinding was achieved by covering four 5-mL syringes containing the randomized local anesthetic. After induction of anesthesia, a pudendal nerve block was performed per standard technique (5 mL superiorly and 5 mL inferiorly each ischial spine) using a pudendal kit. The primary outcome was to evaluate postoperative vaginal pain using a visual analog scale on postoperative days 1, 2, and 3. Secondary outcomes included total analgesic medication usage through postoperative day 3, postoperative voiding and defecatory dysfunction, and impact of vaginal pain on quality of life factors. Results A total of 120 patients were enrolled (60 in each group). There were no significant differences in demographic data, including baseline vaginal pain (P=.88). Postoperative vaginal pain scores were significantly lower in the combined liposomal and bupivacaine group at all time points vs the plain bupivacaine group. Median pain scores for the study and control groups, respectively, were 0 (0–2) and 2 (0–4) for postoperative day 1 (P=.03), 2 (1–4) and 3 (2–5) for postoperative day 2 (P=.05), and 2 (1–4) and 3 (2–5) for postoperative day 3 (P=.02). Vaginal pain scores increased from postoperative day 1 to postoperative days 2 and 3 in both groups. There was a significant decrease in ibuprofen (P=.01) and acetaminophen (P=.03) usage in the study group; however, there was no difference between groups in total opioid consumption through postoperative day 3 (P=.82). There was no difference in successful voiding trials (study 72%, control 82%, P=.30), return of bowel function (P>.99), or quality of life factors (sleep, stress, mood, and activity). Conclusion Preoperative regional pudendal block with a combination of liposomal and plain bupivacaine provided more effective vaginal pain control than plain bupivacaine alone for reconstructive surgery that included posterior colporrhaphy. Given the statistically significant decrease in vaginal pain in the study group, this block may be considered as a potential adjunct for multimodal pain reduction in this patient population.
- Published
- 2021
29. Ultrasound-guided transgluteal injection of the pudendal nerve in cats: a cadaveric study
- Author
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Erin K Keenihan, Kyle G. Mathews, Jessica D. Briley, and Ludovica Chiavaccini
- Subjects
CATS ,General Veterinary ,business.industry ,Pudendal nerve ,Anesthesia ,Medicine ,business ,Cadaveric spasm ,Ultrasound guided - Published
- 2021
30. Terapêutica multimodal do vaginismo: abordagem inovadora por meio de infiltração de pontos gatilho e radiofrequência pulsada do nervo pudendo
- Author
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Luísa Manuela Ribeiro Moreira, Joana Catarina Monteiro da Costa, Luís Miguel Agualusa, and Joana Chaves Gonçalves Rodrigues de Carvalho
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,Vaginismus ,Chronic pain ,Nervo pudendo ,Pulsed radiofrequency ,Pudendal nerve ,Trigger point ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,030202 anesthesiology ,Vaginismo ,Ponto gatilho ,medicine ,Dor crônica ,business ,Radiofrequência pulsada ,030217 neurology & neurosurgery - Abstract
ResumoO vaginismo é uma doença pouco compreendida que se caracteriza por uma contração muscular involuntária dos músculos do pavimento pélvico e do terço externo da vagina durante as tentativas de intercurso sexual, o que resulta em aversão à penetração. Estima‐se que possa afetar entre 1%‐7% da população feminina mundial. Com este relato os autores pretendem apresentar o caso de uma paciente jovem com vaginismo na qual foram usadas técnicas habitualmente do domínio da medicina da dor crônica como parte do seu esquema terapêutico multimodal.AbstractVaginismus is a poorly understood disorder, characterized by an involuntary muscular spasm of the pelvic floor muscles and outer third of the vagina during intercourse attempt, which results in aversion to penetration. It is reported to affect 1%‐7% of women worldwide. With this report the authors aim to describe the case of a young patient with vaginismus in whom techniques usually from the chronic pain domain were used as part of her multimodal therapeutic regimen.
- Published
- 2017
31. Peritoneal Retraction Pocket Defects and Their Important Relationship with Pelvic Pain and Endometriosis
- Author
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Ramiro Cabrera Carranco, Andres Vigeras Smith, Philippe R. Koninckx, Monica Tessmann Zomer, William Kondo, and Claudia Fernandez Berg
- Subjects
Adult ,Ovarian fossa ,medicine.medical_specialty ,Pudendal nerve ,Endometriosis ,Pelvic Pain ,Peritoneal Diseases ,Pelvis ,03 medical and health sciences ,0302 clinical medicine ,Dysmenorrhea ,medicine.ligament ,medicine ,Humans ,Adenomyosis ,Pararectal fossa ,030219 obstetrics & reproductive medicine ,business.industry ,Dissection ,Pelvic pain ,Sacrospinous ligament ,Obstetrics and Gynecology ,medicine.disease ,Surgery ,Dyspareunia ,030220 oncology & carcinogenesis ,Quality of Life ,Female ,Laparoscopy ,Obturator nerve ,Autopsy ,Peritoneum ,medicine.symptom ,Obturator Nerve ,business ,Brazil - Abstract
Objective The objective of this video is to demonstrate different clinical presentations of peritoneal defects (peritoneal retraction pockets) and their anatomic relationships with the pelvic innervation, justifying the occurrence of some neurologic symptoms in association with these diseases. Design Surgical demonstration of complete excision of different types of peritoneal retraction pockets and a comparison with a laparoscopic retroperitoneal cadaveric dissection of the pelvic innervation. Setting Private hospital in Curitiba, Parana, Brazil. Interventions A pelvic peritoneal pocket is a retraction defect in the surface of the peritoneum of variable size and shapes [1] . The origin of defects in the pelvic peritoneum is still unknown [2] . It has been postulated that it is the result of peritoneal irritation or invasion by endometriosis, with resultant scarring and retraction of the peritoneum [ 3 , 4 ]. It has also been suggested that a retraction pocket may be a cause of endometriosis, where the disease presumably settles in a previously altered peritoneal surface [5] . These defects are shown in many studies to be associated with pelvic pain, dyspareunia, and secondary dysmenorrhea 1 , 2 , 3 , 4 . Some studies have shown that the excision of these peritoneal defect improves pain symptoms and quality of life [5] . It is important to recognize peritoneal pockets as a potential manifestation of endometriosis because in some cases, the only evidence of endometriosis may be the presence of these peritoneal defects [6] . In this video, we demonstrate different types of peritoneal pockets and their close relationship with pelvic anatomic structures. Case 1 is a 29-year-old woman, gravida 0, with severe dysmenorrhea and catamenial bowel symptoms (bowel distension and diarrhea/constipation) that were unresponsive to medical treatment. Imaging studies were reported as normal, and a laparoscopy showed a posterior cul-de-sac peritoneal pocket infiltrating the pararectal fossa, with extension to the lateral border of the rectum. Case 2 is a cadaveric dissection of a posterior cul-de-sac peritoneal pocket infiltrating the pararectal fossa, with extension to the pelvic sidewall. After dissection of the obturator fossa, we can observe that the pocket is close to the sacrospinous ligament, pudendal nerve, and some sacral roots. Case 3 is a 31-year-old woman, gravida 1, para 1, with severe dysmenorrhea that was unresponsive to medical treatment and catamenial bowel symptoms (catamenial bowel distention and diarrhea). Imaging studies were reported as normal and a laparoscopy showed left uterosacral peritoneal pocket infiltrating the pararectal fossa in close proximity to the rectal wall. Case 4 is a cadaveric dissection of the ovarian fossa and the obturator fossa showing the proximity between these structures. Case 5 is a 35-year-old woman, gravida 0, with severe dysmenorrhea that was unresponsive to medical treatment, referring difficulty, and pain when walking only during menstruation. A neurologic physical examination revealed weakness in thigh adduction, and the magnetic resonance imaging showed no signs of endometriosis. During laparoscopy, we found a peritoneal pocket infiltrating the ovarian fossa, with involvement in the area between the umbilical ligament and the uterine artery. This type of pocket can easily reach the obturator nerve. Because the obturator nerve and its branches supply the muscle and skin of the medial thigh [ 7 , 8 ], patients may present with thigh adduction weakness or difficulty ambulating [ 9 , 10 ]. Case 6 is a cadaveric dissection of the sacrospinous ligament and the pudendal nerve from a medial approach, between the umbilical artery and the iliac vessels. Case 7 is a 34-year-old woman, gravida 1, para 1, with severe dysmenorrhea and catamenial bowel symptoms as well as deep dyspareunia. The transvaginal ultrasound showed focal adenomyosis and a 2-cm nodule, 9-cm apart from the anal verge, affecting 30% of the bowel circumference. In the laparoscopy, we found a posterior cul-de-sac retraction pocket associated with a large deep endometriosis nodule affecting the vagina and the rectum. In all cases, endometriosis was confirmed by histopathology, and in a 6-month follow-up, all patients showed improvement of bowel, pain, and neurologic symptoms. Conclusion Peritoneal pockets can have different clinical presentations. Depending on the topography and deepness of infiltration, they can be the cause of some neurologic symptoms associated with endometriosis pain. With this video, we try to encourage surgeons to totally excise these lesions and raise awareness about the adjacent key anatomic structures that can be affected.
- Published
- 2021
32. Pudendal Neurolysis by Laparoscopy
- Author
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Lise Lecointre, Elodie Fischbach, Cherif Akladios, Emilie Faller, and Mathilde Pélissié
- Subjects
medicine.medical_specialty ,Internal obturator muscle ,medicine.diagnostic_test ,business.industry ,Decompression ,Pudendal nerve ,Pudendal neuralgia ,Obstetrics and Gynecology ,Decompression, Surgical ,medicine.disease ,Pelvis ,Pudendal Nerve ,Surgery ,medicine.anatomical_structure ,medicine ,Humans ,Laparoscopy ,business ,Neurolysis ,Ischiorectal Fossa ,Pudendal Neuralgia - Abstract
Study Objective To show how pudendal neurolysis can be managed safely with a laparoscopic approach. Design Stepwise demonstration of the technique with narrated video footage. Setting The pudendal nerve is formed from spinal roots at levels S2, S3, and S4. It passes through the pelvis parallel to the pudendal vein and artery. This nerve exits the pelvis between the sacrospinous and sacrotuberous ligaments then passes through Alcock's canal. It can be compressed and responsible for pain in the gluteal and perineal regions. After confirmation of the diagnosis by positive analgesic block with computed tomography infiltration of the pudendal nerve, surgical decompression may be considered. The usual access procedures are the transglutal and transischiorectal ways. Interventions This video shows a total laparoscopic approach for a right pudendal neurolysis. It is a step-by-step didactic video. This technique of decompression of the right pudendal nerve by laparoscopy by means of dissection of the ischiorectal fossa along the right internal obturator muscle, after visualization of the obturator vessels and identification of the pudendal nerve, allowed the section of the right sacrospinous ligament and complete removal with repositioning of the nerve in its path. The nerve was followed until it passed freely through Alcock's canal. The procedure went well and without complications, with clinical improvement on waking up. Conclusion Pudendal nerve neurolysis by laparoscopic technique is a reproducible and safe method for treating pudendal neuralgia, allowing good visualization and dissection of the entire pelvis toward the ischiorectal fossa.
- Published
- 2021
33. Interventional Management for Pelvic Pain
- Author
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Ameet S. Nagpal and Erika L. Moody
- Subjects
medicine.medical_specialty ,Nerve root ,Pudendal nerve ,medicine.medical_treatment ,Physical Therapy, Sports Therapy and Rehabilitation ,Pelvic Pain ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,medicine ,Humans ,Pain Management ,Sacroiliac joint ,Hypogastric Plexus ,business.industry ,Pelvic pain ,Rehabilitation ,Nerve Block ,Pelvic Floor ,Ganglion impar ,Surgery ,medicine.anatomical_structure ,Anesthesia ,Nerve block ,medicine.symptom ,Interventional pain management ,business ,030217 neurology & neurosurgery - Abstract
Interventional procedures can be applied for diagnostic evaluation and treatment of the patient with pelvic pain, often once more conservative measures have failed to provide relief. This article reviews interventional management strategies for pelvic pain. We review superior and inferior hypogastric plexus blocks, ganglion impar blocks, transversus abdominis plane blocks, ilioinguinal, iliohypogastric and genitofemoral blocks, pudendal nerve blocks, and selective nerve root blocks. Additionally, we discuss trigger point injections, sacroiliac joint injections, and neuromodulation approaches.
- Published
- 2017
34. 10: Preoperative levator ani muscle and pudendal nerve injections for pain control after vaginal reconstructive surgery: A three-arm randomized controlled trial
- Author
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Lauren E. Giugale, N. Schott, Pamela Moalli, L. Baranski, and T. Emerick
- Subjects
Reconstructive surgery ,medicine.medical_specialty ,Randomized controlled trial ,Pain control ,business.industry ,law ,Pudendal nerve ,Levator ani muscle ,medicine ,Obstetrics and Gynecology ,business ,Surgery ,law.invention - Published
- 2020
35. 2944 Transgluteal Pudendal Neurolysis
- Author
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AE Reinert, M.E. Castellanos, and M. Hibner
- Subjects
medicine.medical_specialty ,Surgical complication ,business.industry ,Pudendal nerve ,Pudendal neuralgia ,medicine ,Obstetrics and Gynecology ,business ,medicine.disease ,Neurolysis ,Surgery - Abstract
Video Objective To describe the surgical technique of pudendal neurolysis via a transgluteal route as performed at St Joseph's Hospital and Medical Center in Phoenix, Arizona. Setting 68 year old woman with right-sided pudendal neuralgia persistent despite non-surgical treatment. Interventions Right-sided transgluteal surgery for pudendal nerve entrapment. Conclusion Several modifications to the procedure originally described by Dr. Robert Roger may improve post-operative pain and function, and reduce risk of surgical complication.
- Published
- 2019
36. Editorial Commentary: Should Proximal Hamstring Surgery Make You Nervous?
- Author
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Brian M. Devitt
- Subjects
Male ,030222 orthopedics ,Hamstring muscles ,medicine.medical_specialty ,business.industry ,Pudendal nerve ,MEDLINE ,Hamstring Muscles ,030229 sport sciences ,Pudendal Nerve ,Surgery ,Leg injury ,03 medical and health sciences ,0302 clinical medicine ,Tendon Injuries ,medicine ,Humans ,Orthopedics and Sports Medicine ,Muscle, Skeletal ,business ,Surgical treatment ,Hamstring ,Leg Injuries - Abstract
In recent times, there has been an increased awareness of high-grade proximal hamstring injuries, many of which are now being managed surgically. Yet, surgical treatment of these injuries is challenging and carries potential risks of serious neurologic complications. Indeed, it is likely that postoperative neurologic complications are under-recognized. As such, knowledge of the intimate anatomic relation of the pudendal nerve and other neural structures around the proximal hamstring is essential and should provide a road map for safer and more successful surgery.
- Published
- 2018
37. Non-venous Pelvic Pain and Roles for Pelvic Floor PT or Pudendal Nerve Blocks
- Author
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Karolynn T. Echols and Jennifer Rich
- Subjects
medicine.medical_specialty ,Pudendal nerve ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Pelvic Pain ,Biofeedback ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Pain Measurement ,Pain symptoms ,Modalities ,Pelvic floor ,business.industry ,Pelvic pain ,Nerve Block ,Pelvic Floor ,Exercise Therapy ,Pudendal Nerve ,Treatment Outcome ,medicine.anatomical_structure ,Physical therapy ,Female ,Integrative medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Non-venous pelvic pain is a dilemma that can frustrate even the most patient of providers. Managing these conditions can be even more bewildering as they require a multidisciplinary approach in most cases. Diet and lifestyle modifications in addition to physical therapy, biofeedback, medications, surgery and integrative medicine modalities can be used alone or in combination to relieve symptoms and should be individualized after proper evaluation and diagnosis. Because most of these conditions are located in the area of pudendal nerve distribution, pudendal nerve blocks have been very successful in helping to control the pain symptoms and should be used judiciously. Here we discuss the common conditions and how physical therapy and pudendal nerve blocks play a significant role in treatment.
- Published
- 2021
38. The pudendal nerve motor branch regenerates via a brain derived neurotrophic factor mediated mechanism
- Author
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Dan Li Lin, Tessa Askew, Mei Kuang, Brett Hanzlicek, Margot S. Damaser, and Brian Balog
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Nerve Crush ,Pudendal nerve ,Tropomyosin receptor kinase B ,Neuromuscular junction ,Rats, Sprague-Dawley ,03 medical and health sciences ,0302 clinical medicine ,Developmental Neuroscience ,Internal medicine ,medicine ,Animals ,Receptor, trkB ,Brain-derived neurotrophic factor ,business.industry ,Brain-Derived Neurotrophic Factor ,Nerve Regeneration ,Pudendal Nerve ,Rats ,Peripheral ,030104 developmental biology ,medicine.anatomical_structure ,Endocrinology ,nervous system ,Neurology ,Neuropathic pain ,Female ,business ,Tyrosine kinase ,030217 neurology & neurosurgery ,Reinnervation - Abstract
Peripheral nerve injuries can significantly reduce quality of life. While some recover, most do not recover fully, resulting in neuropathic pain and loss of sensation and motor function. Research on the mechanisms of peripheral nerve regeneration could elucidate poor patient outcomes and potential treatments. This study was designed to determine if brain derived neurotrophic factor (BDNF) is necessary for pudendal nerve regeneration and functional recovery. Peripheral administration of tyrosine kinase B functional chimera (TrkB) was used to inhibit the BDNF regenerative pathway. Female Sprague-Dawley rats received tyrosine kinase B functional chimera (TrkB) or saline after a pudendal nerve crush (PNC) or Sham PNC and were divided into three groups: Sham PNC, PNC + Saline, and PNC + TrkB. Seven days after injury, relative βII tubulin expression (1.0 ± 0.2) was significantly decreased after PNC + TrkB compared to PNC + saline (2.9 ± 1.0). Three weeks after injury, BDNF plasma concentration (1320.8 ± 278.1 pg/ml) was significantly reduced in PNC + TrkB compared to PNC + saline rats (2053.4 ± 211.0 pg/ml). Pudendal nerve motor branch firing rate (54.0 ± 9.5 Hz) was significantly decreased in the PNC + TrkB group compared to the PNC + saline group (120.4 ± 17.1 Hz); while nerve firing rate of the PNC + saline group was not significantly different from sham PNC rats (121.8 ± 26.6 Hz). This study demonstrated that peripheral administration of TrkB bound free BDNF and inhibited the regenerative response after PNC. BDNF is necessary for normal PN motor branch recovery after PNC.
- Published
- 2020
39. Treatment of radiation-induced vulvar pain via pudendal nerve block under fluoroscopic guidance
- Author
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Woo Yong Lee, Ji Hyeong Yu, Ye Ji Lee, Jae Yoon Kim, and Yun Hee Lim
- Subjects
Vulvar pain ,Vulvodynia ,Nerve block ,Urology ,medicine.medical_treatment ,Pudendal nerve ,030232 urology & nephrology ,Radiation induced ,lcsh:RC870-923 ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Bladder cancer ,Radiotherapy ,business.industry ,lcsh:Diseases of the genitourinary system. Urology ,medicine.disease ,female genital diseases and pregnancy complications ,Radiation therapy ,Nociception ,Oncology ,030220 oncology & carcinogenesis ,Anesthesia ,business ,Acute pain - Abstract
Vulvar pain is a common complaint in women during reproductive and post-reproductive years. A 70-year-old woman experienced severe intractable vulvar pain after bladder cancer surgery and adjuvant radiation therapy. We performed five fluoroscopy-guided pudendal nerve blocks. Her numeric rating scale decreased from 10 to 3, and after 5 months, her pain was controlled only with oral medication. Pudendal nerve block might stop ongoing sensitization which lead acute nociceptive vulvar pain into chronic neuropathic vulvodynia by attenuating nociceptive stimulation and inflammation.
- Published
- 2020
40. The pudendal nerve block for ambulatory urology: What's old is new again. A quality improvement project
- Author
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Chinonyerem Okoro, Thomas S. Lendvay, Shannon Cannon, Henry Huang, Michael J. Richards, David E. Liston, and Daniel Low
- Subjects
Male ,medicine.medical_specialty ,Urology ,Pudendal nerve ,030232 urology & nephrology ,Lower risk ,Pacu ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Post-anesthesia care unit ,Humans ,Medicine ,Child ,Pain Measurement ,Retrospective Studies ,Pain, Postoperative ,biology ,Scrotoplasty ,business.industry ,Buried penis ,biology.organism_classification ,medicine.disease ,Quality Improvement ,Pediatric urology ,Pudendal Nerve ,Child, Preschool ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Ambulatory ,business - Abstract
Summary Introduction Caudal epidural analgesia (CEA) is a common analgesic technique performed for pediatric penile surgeries; however, it has associated morbidity. The pudendal nerve block (PNB) has been described as an effective analgesic alternative to CEA. Objective In this quality improvement study, we aim to assess the efficacy of PNB as compared to CEA within our ambulatory surgery center (ASC). We demonstrate our initial experience employing PNB for ambulatory pediatric urology procedures. Study design Using retrospective, non-randomized, time-series, observational data, a comparative effectiveness study of CEA and PNB was performed. Patients less than three years old, who underwent circumcision, hypospadias repair, congenital chordee repair, correction of penile angulation/torsion, and buried penis repair with or without scrotoplasty, between January 1, 2015–September 9, 2019 with either CEA or PNB in an ASC at a single institution were included. Standard protocols for local and postoperative analgesia were used. Outcome measures were post anesthesia care unit (PACU) pain scores, morphine rescue rates, and PACU length of stay (LOS). These were analyzed using statistical process control (SPC) charts; standard SPC rules were used to detect special cause variation. Results A total of 999 patients were identified; 746 (74.7%), 172 (17.2%) and 81 (8.1%) received CEA, ultrasound guided PNB (US-PNB) and landmark directed PNB (LD-PNB), respectively. Demographic data was comparable between the three cohorts. There was no special cause variation in the outcome measures between the CEA, US-PNB and LD-PNB cohorts for maximum pain score, morphine rescue rates and PACU LOS. Discussion Pain outcomes and PACU LOS were similar between the CEA, US-PNB and LD-PNB cohorts, suggesting equivalent postoperative pain control between these techniques within our cohort. Previous published data has reported lower postoperative pain scores with PNB as compared to CEA for patients undergoing circumcision and hypospadias repair. Conclusion PNB is non-inferior to CEA for analgesia for pediatric penile surgery, with LD-PNB being as effective as US-PNB. Given the simplicity and documented lower risk profile, PNB may be preferred to CEA for ambulatory pediatric urology procedures. Summary Table . Comparison of Primary and Secondary Outcome Measures Outcome Measure (n) CEA (746) US-PNB (172) LD-PNB (81) Mean of PACU Maximum Pain Score (0–10) 2.50 2.98 2.16 PACU Morphine Administration (%) 2.80 6.94 2.47 PACU Length of Stay (Minutes) 57.77 59.05 57.37 Abbreviations: CEA, caudal epidural anesthesia; PACU post anesthesia care unit; US-PNB, ultrasound guided pudendal nerve block; LD-PNB, landmark directed pudendal nerve block.
- Published
- 2020
41. Efficacy of Electrical Pudendal Nerve Stimulation in Treating Female Stress Incontinence
- Author
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Siyou Wang, Xiaoming Feng, Jianwei Lv, Tingting Lv, and Ge Wang
- Subjects
medicine.medical_specialty ,Urinary Incontinence, Stress ,Urology ,medicine.medical_treatment ,Pudendal nerve ,030232 urology & nephrology ,Electric Stimulation Therapy ,Urinary incontinence ,Electromyography ,Biofeedback ,law.invention ,Pudendal nerve stimulation ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Randomized controlled trial ,law ,medicine ,Humans ,medicine.diagnostic_test ,business.industry ,Therapeutic effect ,Biofeedback, Psychology ,Middle Aged ,Pudendal Nerve ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Anesthesia ,Female ,medicine.symptom ,business - Abstract
To compare the efficacies of electrical pudendal nerve stimulation (EPNS) vs electromyogram biofeedback (BF)-assisted pelvic floor muscle training (PFMT) plus transvaginal electrical stimulation (TES) in treating female stress urinary incontinence (SUI) and to evaluate the posttreatment and long-term efficacies of EPNS for female SUI.Forty-two female SUI patients were randomized into groups I and II, 21 in each group. The two groups were treated by EPNS and BF-assisted PFMT plus TES, respectively, for comparison of their effects. Group III (196 patients) were treated by EPNS for evaluation of its effects. To perform EPNS, long acupuncture needles were deeply inserted into four sacrococcygeal points and electrified to stimulate pudendal nerves. Outcome measures were stress test, 24-hour pad test, and a questionnaire to measure the severity of symptoms and quality of life in women with SUI.After 4 weeks of treatment, the questionnaire score was lower and the therapeutic effect was better in group I (questionnaire score 0 [0, 6] and a ≥ 50% symptom improvement rate of 85.7%, respectively) than in group II (questionnaire score 9 [5.5, 15.5] and a ≥ 50% symptom improvement rate of 28.6%) (both P .01). In group III, complete resolution occurred in 94 cases (48.0%), with a ≥ 50% symptom improvement rate of 85.7%, after 20.3 ± 16.8 sessions of treatment. At the mean follow-up of 52.9 months, complete resolution occurred in 32 (47.1%) of the 68 patients in group III who attained ≥50% posttreatment improvement.EPNS is more effective than BF-assisted PFMT plus TES in treating female SUI. It has good posttreatment and long-term effects on female SUI.
- Published
- 2016
42. The Important Liaison Between Onuf Nucleus–Pudendal Nerve Ganglia Complex Degeneration and Urinary Retention in Spinal Subarachnoid Hemorrhage: An Experimental Study
- Author
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Huseyin Eren, Ayhan Kanat, Esref Kabalar, Coskun Yolas, Cengiz Ozturk, Nezih Akca, Nazan Aydin, Mehmet Dumlu Aydin, Cemal Gundogdu, Dilcan Kotan, Yolas, C, Kanat, A, Aydin, MD, Ozturk, C, Kabalar, E, Akca, N, Eren, H, Gundogdu, C, Kotan, D, Aydin, N, Sakarya Üniversitesi/Tıp Fakültesi/Dahili Tıp Bilimleri Bölümü, and Kotan Dündar, Dilcan
- Subjects
Male ,Sacrum ,Pathology ,medicine.medical_specialty ,Subarachnoid hemorrhage ,Pudendal nerve ,Urinary Bladder ,Apoptosis ,Random Allocation ,03 medical and health sciences ,0302 clinical medicine ,Cerebrospinal fluid ,Dorsal root ganglion ,Anterior Horn Cells ,Ganglia, Spinal ,medicine ,Animals ,cardiovascular diseases ,Lumbar Vertebrae ,Urinary bladder ,business.industry ,Vasospasm ,Arteries ,Organ Size ,Subarachnoid Hemorrhage ,Urinary Retention ,medicine.disease ,Pudendal Nerve ,nervous system diseases ,Conus medullaris ,Disease Models, Animal ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Anesthesia ,Nerve Degeneration ,Surgery ,Rabbits ,Neurology (clinical) ,Neuron ,business ,030217 neurology & neurosurgery - Abstract
Objective The Adamkiewicz artery (AKA) supplies pudendal nerve roots and conus medullaris. The aim of this study was to elucidate if there is any relationship between neurodegenerative changes of the Onuf nucleus (ON)–pudendal nerve ganglia complex secondary to vasospasm of the AKA after spinal subarachnoid hemorrhage (SAH). Methods This study was conducted on 22 rabbits, which were randomly divided into 3 groups: control (n = 5), sham (n = 5), and spinal SAH (n = 12). Experimental spinal SAH was induced at the L2 level. After 2 weeks, the ON–pudendal nerve ganglia complex and AKA were examined histopathologically. Bladder volume values were estimated, and results were analyzed statistically. Results Two animals died within the first week of experiment. Histopathologically, severe vasospasm of the AKA and neuronal degeneration and neuronal apoptosis were observed in the ON–pudendal nerve ganglia complex in 5 animals of the SAH group. The mean volume of the imaginary AKA, mean bladder volumes, and degenerated neuron densities of ON and pudendal nerve ganglia were estimated. We found that vasospasm of the AKA led to numerous neuron degenerations in ON and pudendal ganglia and consequently urinary retention (P Conclusions ON–pudendal nerve ganglia complex degeneration secondary to vasospasm of the AKA may be a cause of urinary retention after spinal SAH.
- Published
- 2016
43. Evaluating the discordant relationship between Tarlov cysts and symptoms of pudendal neuralgia
- Author
-
Rohit Khanna, M.E. Castellanos, M. Hibner, Olga Kalinkin, and Victoria M. Lim
- Subjects
Adult ,Male ,Sacrum ,Tarlov cyst ,medicine.medical_specialty ,Pudendal nerve ,Young Adult ,symbols.namesake ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Cyst ,030212 general & internal medicine ,Fisher's exact test ,Aged ,Pudendal Neuralgia ,Retrospective Studies ,Aged, 80 and over ,030219 obstetrics & reproductive medicine ,business.industry ,Pelvic pain ,Pudendal neuralgia ,Obstetrics and Gynecology ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Perineural Cyst ,Tarlov Cysts ,Pudendal Nerve ,Surgery ,medicine.anatomical_structure ,Dermatome ,symbols ,Female ,medicine.symptom ,Spinal Nerve Roots ,business ,Lumbosacral joint - Abstract
Background Pudendal neuralgia is a painful neuropathic condition involving the pudendal nerve dermatome. Tarlov cysts have been reported in the literature as another potential cause of chronic lumbosacral and pelvic pain. Notably, they are often located in the distribution of the pudendal nerve origin at the S2, S3, and S4 sacral nerve roots and it has been postulated that they may cause similar symptoms to pudendal neuralgia. Literature has been inconsistent on the clinical relevance of the cysts and if they are responsible for symptoms. Objective To evaluate the prevalence of S2–S4 Tarlov cysts at the pudendal nerve origin (S2–S4 sacral nerve roots) in patients specifically diagnosed with pudendal neuralgia, and establish association of patient symptoms with location of Tarlov cyst. Study Design A retrospective study was performed on 242 patients with pudendal neuralgia referred for pelvic magnetic resonance imaging from January 2010 to November 2012. Dedicated magnetic resonance imaging review evaluated for presence, level, site, and size of Tarlov cysts. Among those with demonstrable cysts, subsequent imaging data were collected and correlated with the patients’ clinical site of symptoms. Statistical analysis was performed using χ2, Pearson χ2, and Fisher exact tests to assess significance. Results Thirty-nine (16.1%) patients demonstrated at least 1 sacral Tarlov cyst; and of the 38 patients with complete pain records, 31 (81.6%) had a mismatch in findings. A total of 50 Tarlov cysts were identified in the entire patient cohort. The majority of the Tarlov cysts were found at the S2–S3 level (32/50; 64%). Seventeen patients (44.7%) revealed unilateral discordant findings: unilateral symptoms on the opposite side as the Tarlov cyst. In addition, 14 (36.8%) patients were detected with bilateral discordant findings: 11 (28.9%) had bilateral symptoms with a unilateral Tarlov cyst, and 3 (7.9%) had unilateral symptoms with bilateral cysts. Concordant findings were only demonstrated in 7 patients (18.4%). No significant association was found between cyst size and pain laterality (P = .161), cyst volume and pain location (P = .546), or cyst size and unilateral vs bilateral pain (P = .997). Conclusion The increased prevalence of Tarlov cysts is likely not the etiology of pudendal neuralgia, yet both could be due to similar pathogenesis from part of a focal or generalized condition.
- Published
- 2020
44. Multimodality post proctologic surgery pain control
- Author
-
Afshin Iranpour and Ramakrishna Boddapati
- Subjects
medicine.medical_specialty ,Gabapentin ,business.industry ,Pudendal nerve ,Gastroenterology ,Perioperative ,Surgery ,03 medical and health sciences ,Regimen ,0302 clinical medicine ,Patient satisfaction ,030220 oncology & carcinogenesis ,medicine ,030211 gastroenterology & hepatology ,Ketamine ,Dexmedetomidine ,business ,Surgical incision ,medicine.drug - Abstract
A multimodal analgesia strategy is achievable and safe in patients undergoing proctologic surgery and it reduces the need for opioids use postoperatively. Pre-emptive preoperative analgesia prior to surgical incision yields better pain control compared to postoperative pain regimen alone. Recent evidence supports the use of multimodal analgesia perioperatively eliminating or reducing the need for postoperative opioids for pain control and thus reducing the undesirable narcotic-related side effects. Components of multimodal analgesia include opioids, non-steroidal anti-inflammatory drugs, acetaminophen (paracetamol), gabapentin, ketamine, dexamethasone, dexmedetomidine, and local anesthetics administered by infiltration, neuraxial, or pudendal nerve block. This approach decreases perioperative morbidity, accomplishes early hospital discharge, and enhances patient satisfaction without compromising on the safety and quality of care.
- Published
- 2019
45. Preliminary results of abnormal pudendal nerve function in children with encopresis, incontinence and/or neurogenic bladder
- Author
-
M. Podgurskaya, D. Kanshina, and O I Vinogradov
- Subjects
medicine.medical_specialty ,Neurology ,Encopresis ,business.industry ,Pudendal nerve ,Urology ,medicine ,Neurology (clinical) ,medicine.symptom ,business - Published
- 2019
46. Pudendal Nerve Neuromodulation Via Dry Needling: A Possible Treatment Appropach For Pudendal Neuralgia
- Author
-
Kelly Sammis
- Subjects
Dry needling ,business.industry ,Anesthesia ,Pudendal nerve ,Rehabilitation ,Pudendal neuralgia ,Medicine ,Physical Therapy, Sports Therapy and Rehabilitation ,business ,medicine.disease ,Neuromodulation (medicine) - Published
- 2019
47. Vascular Entrapment of Both the Sciatic and Pudendal Nerves Causing Persistent Sciatica and Pudendal Neuralgia
- Author
-
Taner Usta, Gulfem Basol, Ahmet Kale, and Isa Cam
- Subjects
Adult ,medicine.medical_specialty ,Pudendal nerve ,Lumbosacral Plexus ,Lumbosacral trunk ,Pelvic Pain ,Pelvis ,medicine.nerve ,Sciatica ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Pudendal Neuralgia ,030219 obstetrics & reproductive medicine ,business.industry ,Pelvic pain ,Pudendal neuralgia ,Obstetrics and Gynecology ,Decompression, Surgical ,medicine.disease ,Sciatic Nerve ,Pudendal Nerve ,Surgery ,Sacral plexus ,Dyspareunia ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Laparoscopy ,Sciatic nerve ,Chronic Pain ,medicine.symptom ,business - Abstract
Study Objective To demonstrate the laparoscopic approach to malformed branches of the vessels entrapping the nerves of the sacral plexus. Design A step-by-step explanation of the surgery using video (educative video) (Canadian Task force classification II). The university's Ethics Committee ruled that approval was not required for this video. Setting Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey. Patient A 26-year-old patient who had failed medical therapy and presented with complaints of numbness and burning pain on the right side of her vagina and pain radiating to her lower limbs for a period of approximately 36 months. Intervention The peritoneum was incised along the external iliac vessels, and these vessels were separated from the iliopsoas muscle on the right side of the pelvis. The laparoscopic decompression of intrapelvic vascular entrapment was performed at 3 sites: the lumbosacral trunk, sciatic nerve, and pudendal nerve. The aberrant dilated veins were gently dissected from nerves, and then coagulated and cut with the LigaSure sealing device (Medtronic, Minneapolis, Minn). Measurements and Main Results The operation was completed successfully with no complications, and the patient was discharged from the hospital 24 hours after the operation. At a 6-month follow-up, she reported complete resolution of dyspareunia and sciatica (visual analog scale score 1 of 10). Conclusion A less well-known cause of chronic pelvic pain is compression of the sacral plexus by dilated or malformed branches of the internal iliac vessels. Laparoscopic management of vascular entrapment of the sacral plexus has been described by Possover et al 1 , 2 and Lemos et al [3] . This procedure appears to be feasible and effective, but requires significant experience and familiarity with laparoscopy techniques and pelvic nerve anatomy.
- Published
- 2019
48. Electrical management of neurogenic lower urinary tract disorders
- Author
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Charles Joussain and P Denys
- Subjects
Sacrum ,S3 neuromodulation ,medicine.medical_specialty ,Nerve root ,medicine.medical_treatment ,Urinary system ,Pudendal nerve ,Urology ,Electric Stimulation Therapy ,Stimulation ,Lower Urinary Tract Symptoms ,Lower urinary tract symptoms ,Sacral anterior root stimulation ,medicine ,Humans ,Orthopedics and Sports Medicine ,Urinary Bladder, Neurogenic ,Tibial nerve ,business.industry ,Patient Selection ,Rehabilitation ,Neurogenic lower urinary tract dysfunction ,medicine.disease ,Urinary tract disorder ,Pudendal Nerve ,Transcranial magnetic stimulation ,Electrical stimulation ,Practice Guidelines as Topic ,Tibial Nerve ,Spinal Nerve Roots ,business - Abstract
Management of lower urinary tract dysfunction (LUTD) in neurological diseases remains a priority because it leads to many complications such as incontinence, renal failure and decreased quality of life. A pharmacological approach remains the first-line treatment for patients with neurogenic LUTD, but electrical stimulation is a well-validated and recommended second-line treatment. However, clinicians must be aware of the indications, advantages and side effects of the therapy. This report provides an update on the 2 main electrical stimulation therapies for neurogenic LUTD – inducing direct bladder contraction with the Brindley procedure and modulating LUT physiology (sacral neuromodulation, tibial posterior nerve stimulation or pudendal nerve stimulation). We also describe the indications of these therapies for neurogenic LUTD, following international guidelines, as illustrated by their efficacy in patients with neurologic disorders. Electrical stimulation could be proposed for neurogenic LUTD as second-line treatment after failure of oral pharmacologic approaches. Nevertheless, further investigations are needed for a better understanding of the mechanisms of action of these techniques and to confirm their efficacy. Other electrical investigations, such as deep-brain stimulation and repetitive transcranial magnetic stimulation, or improved sacral anterior root stimulation, which could be associated with non-invasive and highly specific deafferentation of posterior roots, may open new fields in the management of neurogenic LUTD.
- Published
- 2015
49. Postpartum Incontinence. Narrative Review
- Author
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Rafael Alós, A. Solana, Rodolfo Rodríguez, M. Soledad Carceller, Roberto Lozoya, Andrés Frangi, and M. Dolores Ruiz
- Subjects
Episiotomy ,medicine.medical_specialty ,External anal sphincter ,business.industry ,Pudendal nerve ,medicine.medical_treatment ,digestive, oral, and skin physiology ,General Engineering ,digestive system ,Surgery ,medicine.anatomical_structure ,Perineal tear ,otorhinolaryngologic diseases ,medicine ,Etiology ,Fecal incontinence ,Sphincter ,Childbirth ,medicine.symptom ,business - Abstract
The development of fecal incontinence after childbirth is a common event. This incontinence responds to a multifactorial etiology in which the most common element is external anal sphincter injury. There are several risk factors, and it is very important to know and avoid them. Sphincter injury may result from perineal tear or sometimes by incorrectly performing an episiotomy. It is very important to recognize the injury when it occurs and repair it properly. Pudendal nerve trauma may contribute to the effect of direct sphincter injury. Persistence of incontinence is common, even after sphincter repair. Surgical sphincteroplasty is the standard treatment of obstetric sphincter injuries, however, sacral or tibial electric stimulation therapies are being applied in patients with sphincter injuries not repaired with promising results.
- Published
- 2015
50. Restoration From Acute Urinary Dysfunction Using Utah Electrode Arrays Implanted Into the Feline Pudendal Nerve
- Author
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Shana R. Black, Richard A. Normann, Kiran S. Mathews, Patrick C. Cartwright, Heather A. C. Wark, and Kenneth J. Gustafson
- Subjects
Male ,medicine.medical_specialty ,External anal sphincter ,Pudendal nerve ,Urinary system ,Urology ,Electric Stimulation Therapy ,Urinary incontinence ,Underactive bladder ,Reflex ,medicine ,Animals ,Urinary Bladder, Overactive ,business.industry ,Urethral sphincter ,Muscle, Smooth ,Recovery of Function ,General Medicine ,Urination Disorders ,medicine.disease ,Neuromodulation (medicine) ,Electrodes, Implanted ,Pudendal Nerve ,Disease Models, Animal ,Urinary Incontinence ,Anesthesiology and Pain Medicine ,Neurology ,Overactive bladder ,Cats ,Neurology (clinical) ,medicine.symptom ,business ,Muscle Contraction - Abstract
Objectives To investigate intrafascicular pudendal nerve stimulation in felines as a means to restore urinary function in acute models of urinary incontinence, overactive bladder, and underactive bladder. Materials and Methods Felines were anesthetized, and high-electrode-count (48 electrodes; 25 electrodes/mm2) electrode arrays were implanted intrafascicularly into the pudendal nerve trunk. Electrodes were mapped for their ability to selectively or nonselectively excite the external anal sphincter, external urethral sphincter, and the detrusor bladder muscle. Statistical analysis was carried out to quantify reflexive voiding efficiencies, mean impedances of the microelectrodes used in this study, and to determine what differences, if any, in bladder contraction amplitudes were evoked by different electrode configurations. Results Multielectrode arrays implanted into the pudendal nerve trunk were able to selectively and nonselectively excite genitourinary muscles. After inducing urinary incontinence with bilateral pudendal nerve transections (proximal to the implants), electrical stimulation delivered through certain microelectrodes was able to significantly reduce leaking (p = 0.008). Electrical stimulation delivered through detrusor selective electrodes was able to inhibit reflexive bladder contractions and excite bladder contractions, depending on the stimulation frequency. Specific electrode configurations were able to drive significantly (p < 0.001) larger bladder contractions than other electrode configurations, depending on the preparation. Successful reflexively or electrically driven bladder contractions were achieved in 46% and 38% of the preparations, respectively, an observation that has not been noted in previously published feline pudendal stimulation studies. Conclusions Multielectrode arrays implanted intrafascicularly into the pudendal nerve trunk may provide a promising new clinical neuromodulation therapy for the restoration of urinary function.
- Published
- 2015
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