Pudendal nerve entrapment (PNE) diagnosis is not standardized. This leads to a significant delay in diagnosis, impacting quality of life and potentially compromising therapeutic outcomes (1,2). The main objective is to find the role of neurophysiological study (NFS) and Imaging-guided pudendal nerve infiltration (ImPNI) in PNE diagnosis and patient selection for surgery. The second outcome is evaluating the predictive power of NFS and ImPNI.

A retrospective, multicentric study was conducted in the three urology departments, including 88 patients with PNE refractory to conservative treatment and referred due to chronic pelvic pain (CPP).  Patient data, including NFS results, Imaging-guided PNI, and surgical outcomes, were evaluated after a one-year follow-up. A visual analogue scale (VAS) was used to assess intervention response. Test performance metrics for NFS and Imaging-guided PNI and binary logistic regression were used to determine their predictive value for postoperative improvement.

A total of 144 CPP patients were analyzed. 88 were diagnosed with PNE. All patients had NFS, and Imaging-guided PNI was performed in 69 (78.4%), with 60 (68.2%) showing symptom improvement. Among the 40 patients (85%) who underwent pudendal nerve decompression surgery, 75% improved after surgery, and 20% did not have any response. 
The combined use of NFS and Imaging-guided PNI showed a sensitivity of 79% and a specificity of 85.7%, with PPV of 98% and PNV of 30%. Both NFS and ImPNI were significant predictors of surgical success with p-values of 0.013 [ 95% CI: -23.6 - -19.9] and 0.003 [95% CI: -20.6 - -18.5], respectively. 
The primary limitations of this study are its retrospective nature and the absence of a control group.

This study represents a critical step toward standardizing the diagnosis of pudendal nerve entrapment (PNE). It provides evidence supporting the combined use of NFS and ImPNI to identify suitable candidates for pudendal nerve decompression surgery.
We looked for reliable complementary exams to assist PNE diagnosis and patient selection for surgical PNE treatment. 
We found that NFS and ImPNI used together, have high specificity and PPV that make these tests crucial for PNE diagnosis, management, and prediction of surgical outcomes. The best outcomes are seen in patients with an NFS positive study (PNE suspicious) and a image-guided positive response (symptoms improvement after the procedure).

Neurophysiologic study and Imaging-guided PNI are essential and highly reliable tools for diagnosing PNE. Imaging-guided PNI is a valuable predictor of surgical outcomes. These findings enable precise patient selection for surgery, ensuring optimal surgical outcomes.

Luesma MJ, Galé I, Fernando J. Diagnostic and therapeutic algorithm for pudendal nerve entrapment syndrome. Medicina clinica. Jul 23 2021;157(2):71-78. Algoritmo diagnóstico y terapéutico del síndrome de atrapamiento del nervio pudendo. doi:10.1016/j.medcli.2021.02.012
Possover M, Forman A. Voiding Dysfunction Associated with Pudendal Nerve Entrapment. Current bladder dysfunction reports. Dec 2012;7(4):281-285. doi:10.1007/s11884-012-0156-5