The drug-resistant pudendal neuralgia management: A systematic review.

Aims: Pudendal neuralgia (PN) due to pudendal nerve entrapment is a well-known disease in medical community but both diagnostic and treatment may be delayed for patients. The goal of this study was to achieve a systematic review of the published treatments of PN in order to help physician to take their decision to treat PN.
Methods: A Systematic review based on MEDLINE, Embase, and Cochrane databases was performed to identify articles related to PN. Studies involving ≥ 10 patients presenting PN according to Nantes's criteria who were managed with an intervention for their pain were reviewed. Data were extracted manually for qualitative analysis.
Results: Fifteen studies involving 672 patients (mean age 53.2 +/-5.1, SD 95%) were included. Nine different types of treatments were evaluated. Effectiveness of the treatments was heterogeneously assessed. Pain improvement was achieved in 41% to 100%, 13.4% to 100%, 60% to 100%, 12.2% to 100% in immediate, 3-month, 6-month, and 1-year post procedure, respectively. Complications reported were all grade ≤ II of Dindo-Clavien classification's. Given the heterogeneity of the outcomes measures and the lack of homogeneous prospective studies, no recommendation could be established to choose in between treatments. Methodological quality of the studies was heterogeneous.
Conclusion: Many treatments seems available for drug-resistant PN. Given the heterogeneity of the outcomes measures and the lack of homogeneous prospective studies, no recommendation could be established to determine the best management strategy. Further studies about PN management are needed and should have common endpoint and follow-up.
(© 2018 Wiley Periodicals, Inc.)