Pudendal Nerve Neuralgia: Symptoms and minimal invasive treatments.

López-Fando Lavalle L1, Fernández A A1, Gómez de Vicente J M1, Sánchez Guerrero C1, Jiménez-Cidre M A1, Burgos Revilla J1

Research Type

Clinical

Abstract Category

Pelvic Pain Syndromes / Sexual Dysfunction

Abstract 519
Open Discussion ePosters
Scientific Open Discussion ePoster Session 28
Friday 31st August 2018
12:50 - 12:55 (ePoster Station 3)
Exhibition Hall
Pain, Pelvic/Perineal Neuropathies: Peripheral Surgery Pain, other Neuromodulation
1. Hospital Ramón y Cajal. Madrid
Presenter
L

Luís López-Fando Lavalle

Links

Poster

Abstract

Hypothesis / aims of study
The Pudendal Nerve Neuralgia (PNN) is an uncommon cause of chronic pelvic pain, with many treatment options. Our PNN experience is presented: symptoms associated, studies performed and management using minimal invasive treatments.
Study design, materials and methods
Data were retrospectively collected from the clinical records between the years 2015 and 2017: symptoms, diagnostic studies, treatments and the response of those patients.
Results
24 patients were collected. 21 (87.5%) were females and 3 (12.5%) males. All of them presented PNN diagnosed using Nantes criteria with bad response to oral drugs. The mean time between the beginning of the symptoms and the diagnosis was 4.06 years.
Symptoms of the patients are collected in the Table 1. Urodynamic studies were developed to 16 (66.7%) patients. All of them were pathologic, the results are in Table 1.
Neurophysiological studies were performed to 16 (66.7%) patients. 75% (12 studies) were pathologic (Table 2). 4 patients did not have an image study, 10 (41.7%) had a CT and 13 (54%) a MRI. No pathologies were founded. 
Due to the lack of response to oral drugs, different minimal invasive treatments were performed.  A positive response to the treatment was defined if the patient had a god pain control without other treatments. At the time of the analysis, 5 patients are pending to start minimal invasive approach, so Table 2 resumes the minimal invasive treatments executed and their response in 19 patients.
8 patients did not achieve a positive response.  Previously, they received those treatments: Local infiltration 100% (8), radiofrequency 37.5% (3), physical therapy 12.5% (1) and neuromodulation 12.5% (1). Surgical option was offered by laparoscopic decompression. At the time of the analysis, 5 patients undergone through surgery with a total control of the pain. The remaining 3 patients are pending of surgery at the time of the analysis.
Interpretation of results
We found that the most common accompanying symptoms in the PNN are the urinary ones (75%), even higher than other symptoms considered complementaries by Nante’s criteria like dyspareunia or defecation disorders. Moreover, all the urodynamic studies performed were pathologic. So urinary symptoms may have more weight in PNN diagnosis and treatment. 
Different treatments options were evaluated, reaching up to a 57.9% of pain control with minimal invasive treatments. In follow up,  percentage may decrease due to lack of longtime response with technics like local infiltration. In those patients who did not show good response, surgical option achieved satisfactory pain control.
Concluding message
1.	PNN has a delayed diagnosis with a mean of 4.06 years.
2.	Urinary symptoms are the most prevalent after the pain.
3.	Minimal invasive treatments were able to control pain in 57.9% of the patients.
4.	Laparoscopic pudendal decompression is an alternative in patients with no response to other treatments.
Figure 1
Figure 2
Disclosures
Funding None Clinical Trial No Subjects Human Ethics not Req'd Retrospective serie Helsinki Yes Informed Consent Yes