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Ran J, Lu F, Xu L, Du Y, Liu L, Qi T, Zhou X, Zhang Y, Liu D, Wang R, Li X. Efficacy of ganglion impar block combined with pudendal nerve pulsed radiofrequency for pudendal neuralgia management-a randomized clinical trial. Trials 2024; 25:316. [PMID: 38741220 DOI: 10.1186/s13063-024-08152-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Pudendal neuralgia is a chronic and debilitating condition. Its prevalence ranges from 5 to 26%. Currently, therapeutic approaches to treat pudendal neuralgia include patient education, medication management, psychological and physical therapy, and procedural interventions, such as nerve block, trigger point injections, and surgery. Drug therapy has a limited effect on pain relief. A pudendal nerve block may cause a significant decrease in pain scores for a short time; however, its efficacy significantly decreases over time. In contrast, pudendal nerve pulsed radiofrequency can provide pain relief for 3 months, and ganglion impar block has been widely used for treating chronic perineal pain and chronic coccygodynia. This study aimed to determine the efficacy and safety of monotherapy (pudendal nerve pulsed radiofrequency) and combination therapy (pudendal nerve pulsed radiofrequency plus ganglion impar block) in patients with pudendal neuralgia. METHODS This randomized, controlled clinical trial will include 84 patients with pudendal neuralgia who failed to respond to drug or physical therapy. Patients will be randomly assigned into one of the two groups: mono or combined treatment groups. The primary outcome will be a change in pain intensity measured using the visual analog scale. The secondary outcomes will include a Self-Rating Anxiety Scale score, Self-Rating Depression Scale score, the use of oral analgesics, the Medical Outcomes Study Health Survey Short Form-36 Item score, and the occurrence of adverse effects. The study results will be analyzed using intention-to-treat and per-protocol analyses. Primary and secondary outcomes will be evaluated between the mono and combined treatment groups. Subgroup analyses will be conducted based on the initial ailment, age, and baseline pain intensity. The safety of the treatment will be assessed by monitoring adverse events, which will be compared between the two groups. DISCUSSION This study protocol describes a randomized, controlled clinical trial to determine the efficacy and safety of mono and combination therapies in patients with pudendal neuralgia. The study results will provide valuable information on the potential benefits of this combination therapy and contribute to the development of more effective and safer treatments for patients with pudendal neuralgia. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2200061800).
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Affiliation(s)
- Jiao Ran
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fan Lu
- Department of Pain Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Le Xu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Du
- Department of Anesthesiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, West Section 2, 1St Ring Road, Qingyang District, Chengdu City, Sichuan Province, China
| | - Li Liu
- Sichuan Science City Hospital, No. 64 Mianshan Road, Youxian District, Mianyang City, Sichuan Province, China
| | - Tao Qi
- Department of Pain Management, The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, 12 Qiao Road, Jinniu District, Chengdu, China
| | - Xiaoli Zhou
- No.903 Hospital, the Affiliated Hospital of Chengdu Medical College, No. 9 Huafeng New Village, Middle Section of Taiping Road, Jiangyou City, Mianyang City, China
| | - Yulin Zhang
- Department of Pain Management, The Second Clinical College of North Sichuan Medical College, Nanchong Central Hospital (Beijing Anzhen Hospital Nanchong Hospital), No. 97, Renmin South Road, Shunqing District, Nanchong, 637000, Sichuan, China
| | - Dong Liu
- Department of Pain Management, Chengdu Second People's Hospital, No. 10 Qingyunnan Street, Jinjiang District, Chengdu, China
| | - Rurong Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Xuehan Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
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Levin D, Van Florcke D, Schmitt M, Kendall LK, Patel A, Doan LV, Kirpekar M. Fluoroscopy-Guided Transgluteal Pudendal Nerve Block for Pudendal Neuralgia: A Retrospective Case Series. J Clin Med 2024; 13:2636. [PMID: 38731163 PMCID: PMC11084891 DOI: 10.3390/jcm13092636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objective: Pudendal neuralgia is a distressing condition that presents with pain in the perineum. While a positive anesthetic pudendal nerve block is one of the essential criteria for diagnosing this condition, this block can also provide a therapeutic effect for those afflicted with pudendal neuralgia. There are multiple ways in which a pudendal nerve block can be performed. The objective of this study is to share our results and follow-up of fluoroscopy-guided transgluteal pudendal nerve blocks. Methods: This is a retrospective case series. Included were 101 patients who met four out of the five Nantes criteria (pain in the anatomical territory of the pudendal nerve, pain worsened by sitting, pain that does not wake the patient up at night, and no objective sensory loss on clinical examination) who did not respond to conservative treatment and subsequently underwent a fluoroscopy-guided transgluteal pudendal nerve block. Therapeutic success was defined as a 30% or greater reduction in pain. Success rates were calculated, and the duration over which that success was sustained was recorded. Results: For achieving at least 30% relief of pain, using worst-case analysis, the success rate at two weeks was 49.4% (95% CI: 38.5%, 60.3%). In addition to pain relief, patients experienced other therapeutic benefits, such as reductions in medication use and improvements in activities of daily living. Conclusions: Fluoroscopy-guided transgluteal pudendal nerve block appears to be effective in patients who have pudendal neuralgia that is resistant to conservative therapy, with good short-term success.
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Affiliation(s)
- Danielle Levin
- Department of Anesthesiology, Perioperative Care & Pain Medicine, New York University Langone Health, New York, NY 10016, USA; (D.V.F.); (L.V.D.)
| | - Daniel Van Florcke
- Department of Anesthesiology, Perioperative Care & Pain Medicine, New York University Langone Health, New York, NY 10016, USA; (D.V.F.); (L.V.D.)
| | - Monika Schmitt
- Department of Physical Medicine and Rehabilitation, New York University Langone Health, New York, NY 10016, USA; (M.S.); (L.K.K.)
| | - Lucinda Kurzava Kendall
- Department of Physical Medicine and Rehabilitation, New York University Langone Health, New York, NY 10016, USA; (M.S.); (L.K.K.)
| | - Alopi Patel
- Department of Anesthesiology, Critical Care & Pain Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA;
| | - Lisa V. Doan
- Department of Anesthesiology, Perioperative Care & Pain Medicine, New York University Langone Health, New York, NY 10016, USA; (D.V.F.); (L.V.D.)
| | - Meera Kirpekar
- Department of Anesthesiology, Perioperative Care & Pain Medicine, New York University Langone Health, New York, NY 10016, USA; (D.V.F.); (L.V.D.)
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Boogaard LL, Notten K, Kluivers K, Van der Wal S, Maal TJJ, Verhamme L. Accuracy of augmented reality-guided needle placement for pulsed radiofrequency treatment of pudendal neuralgia: a pilot study on a phantom model. PeerJ 2024; 12:e17127. [PMID: 38560457 PMCID: PMC10981882 DOI: 10.7717/peerj.17127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Background Pudendal neuralgia (PN) is a chronic neuropathy that causes pain, numbness, and dysfunction in the pelvic region. The current state-of-the-art treatment is pulsed radiofrequency (PRF) in which a needle is supposed to be placed close to the pudendal nerve for neuromodulation. Given the effective range of PRF of 5 mm, the accuracy of needle placement is important. This study aimed to investigate the potential of augmented reality guidance for improving the accuracy of needle placement in pulsed radiofrequency treatment for pudendal neuralgia. Methods In this pilot study, eight subjects performed needle placements onto an in-house developed phantom model of the pelvis using AR guidance. AR guidance is provided using an in-house developed application on the HoloLens 2. The accuracy of needle placement was calculated based on the virtual 3D models of the needle and targeted phantom nerve, derived from CBCT scans. Results The median Euclidean distance between the tip of the needle and the target is found to be 4.37 (IQR 5.16) mm, the median lateral distance is 3.25 (IQR 4.62) mm and the median depth distance is 1.94 (IQR 7.07) mm. Conclusion In this study, the first method is described in which the accuracy of patient-specific needle placement using AR guidance is determined. This method could potentially improve the accuracy of PRF needle placement for pudendal neuralgia, resulting in improved treatment outcomes.
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Affiliation(s)
- Lars L. Boogaard
- Radboudumc 3D Lab, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kim Notten
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kirsten Kluivers
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Selina Van der Wal
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Thomas J. J. Maal
- Radboudumc 3D Lab, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Luc Verhamme
- Radboudumc 3D Lab, Radboud University Medical Centre, Nijmegen, The Netherlands
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Celhay O, Roman H, Pasticier G, Calvarin E, Gomez C, Susperregui J, Palamara C, Michiels C. Combined Decompression of Pudendal and Inferior Cluneal Nerves for Entrapment Neuralgias Using Transperitoneal Robotic Laparoscopy: Feasibility and Our 4 Step Technique. J Minim Invasive Gynecol 2024:S1553-4650(24)00152-3. [PMID: 38527704 DOI: 10.1016/j.jmig.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/07/2024] [Accepted: 03/22/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To demonstrate the feasibility of a combined decompression of pudendal and inferior cluneal nerves for entrapment syndrome using a transperitoneal robotic laparoscopy. DESIGN Demonstration of our 4-step technique with narrated video footage. SETTING Pudendal and inferior cluneal neuralgias caused by an entrapment syndrome are both responsible for perineal pain [1]. Although more precise data are lacking, these 2 neuralgias are frequently associated. Failure of surgical pudendal nerve decompression in the early 2000 has driven to discover the entity of a potential entrapment syndrome of the posterior cutaneous nerve of the tight and its inferior cluneal branches between the ischium bone and the sacrotuberous ligament [2]. The corresponding neuralgia is responsible for a neuropathic pain to a more posterior part of the perineum and the thigh, without any neurovegetative symptom. In case of failure of medical treatment, surgery can be proposed using an invasive open transgluteal approach as a standard treatment [3-5]. INTERVENTIONS Transperitoneal robotic laparoscopy for a mini-invasive releasing of both pudendal and inferior cluneal nerves, following a 4-step technique: 1. Opening of the peritoneum between the external iliac vessels and the umbilical ligament 2. Dissection of the internal iliac and pudendal arteries up to the pudendal nerve 3. Section of the sacrospinous ligament and release of the pudendal nerve 4. Section of the sacrotuberous ligament and release of the inferior cluneal nerve CONCLUSION: Previously, pudendal and inferior cluneal neuralgias have been managed with an invasive open transgluteal surgery. Here, we demonstrate the feasibility of a mini-invasive transperitoneal robotic laparoscopy, with a standardized 4-step surgical technique. VIDEO ABSTRACT.
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Affiliation(s)
- Olivier Celhay
- Department of Urology and Robotic Surgery, Clinique Tivoli-Ducos (Drs. Celhay, Pasticier, Susperregui, Palamara, and Michiels), Bordeaux, France.
| | - Horace Roman
- IFEMEndo, Clinique Tivoli-Ducos (Dr. Roman), Bordeaux, France
| | - Gilles Pasticier
- Department of Urology and Robotic Surgery, Clinique Tivoli-Ducos (Drs. Celhay, Pasticier, Susperregui, Palamara, and Michiels), Bordeaux, France
| | - Estelle Calvarin
- Physiotherapy Center of Parc Rivière (Calvarin), Bordeaux, France
| | | | - Jocelyn Susperregui
- Department of Urology and Robotic Surgery, Clinique Tivoli-Ducos (Drs. Celhay, Pasticier, Susperregui, Palamara, and Michiels), Bordeaux, France
| | - Corinne Palamara
- Department of Urology and Robotic Surgery, Clinique Tivoli-Ducos (Drs. Celhay, Pasticier, Susperregui, Palamara, and Michiels), Bordeaux, France
| | - Clément Michiels
- Department of Urology and Robotic Surgery, Clinique Tivoli-Ducos (Drs. Celhay, Pasticier, Susperregui, Palamara, and Michiels), Bordeaux, France
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Piñeiro-Franco L, Alonso-Calvete A, Da Cuña-Carrera I. Management of pudendal neuralgia with electrical stimulation. A systematic review. Actas Urol Esp 2024:S2173-5786(24)00008-8. [PMID: 38365090 DOI: 10.1016/j.acuroe.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/09/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION AND OBJECTIVE Pudendal neuralgia is a severely intense, painful, neuropathic condition, involving the dermatome of the pudendal nerve (S2, S3, S4). The diagnosis is complex and usually takes many years to be made. Techniques that use electrical current have been shown to decrease pain and improve quality of life in patients with this condition. The aim of this review was to analyze the existing literature on the effects of electrical current in the treatment of patients with pudendal neuralgia. MATERIAL AND METHODS A literature search was carried out in PubMed, Cinahl, Medline, Cochrane Library, ENFISPO, PEDro, Scopus and Web of Science databases, using the search terms "Electric Stimulation Therapy", "pudendal neuralgia" and "pudendal nerve entrapment". RESULTS The most frequently repeated intervention is pulsed radiofrequency. Other techniques used are transcutaneous electrical nerve stimulation, pulsed electromagnetic field therapy and neuromodulation. All studies show significant improvement in pain, analgesic intake, depression-anxiety or quality of life. CONCLUSIONS The application of electrical current seems to be effective in the management of pudendal neuralgia. The scientific evidence is scarce, of poor methodological quality, and its use is based on the efficacy demonstrated in other indications of chronic pain.
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Affiliation(s)
- L Piñeiro-Franco
- Facultad de Fisioterapia, Universidad de Vigo, Vigo, Pontevedra, Spain
| | - A Alonso-Calvete
- Facultad de Fisioterapia, Universidad de Vigo, Vigo, Pontevedra, Spain.
| | - Iria Da Cuña-Carrera
- Facultad de Fisioterapia, Universidad de Vigo, Vigo, Pontevedra, Spain; Grupo de Investigación Fisioterapia Clínica (FS1), Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Galicia, España
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Ding H, Chen Q, Zhan H, Jia Y, Ren J, Ye J. Bibliometric Analysis of Research Relating to Perineal Pain Reported over the Period 1981 to 2021. J Pers Med 2023; 13:jpm13030542. [PMID: 36983723 PMCID: PMC10052530 DOI: 10.3390/jpm13030542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/05/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Perineal pain is a painful neuropathic condition, which does not have a standard diagnostic or treatment approach. As such, we sought to evaluate the global scientific output of research into perineal pain and explore trends from 1981 to 2021 using bibliometric methods. METHODS Articles on perineal pain were retrieved from the Web of Science (WoS) database. We analyzed the content and quality of publications from within the specified timeframe. We also utilized VOSviewer to mine and cluster data from retrieved articles. RESULTS A total of 1917 articles were collected. The number of related papers published increased year by year. Articles were most frequently published by authors in the United States and France. Although the US remains at the center of this field, publications from China have become more frequent in recent years. We also found that French academic institutions dominate the field of perineal pain, and Jean-Jacques Labat from Nantes Universite is the most published author in the field. "Episiotomy", "pain", "management", "prostatectomy", "pelvic pain", and "complication" were frequently cited as keywords. CONCLUSION The increasing number of publications each year indicates that perineal pain has gained more attention as an important research topic.
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Affiliation(s)
- Huang Ding
- Department of Pain, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Qin Chen
- Operation Room, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430060, China
| | - Huiming Zhan
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - Yifan Jia
- Department of Pain, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Juan Ren
- Department of Respiratory Medicine, General Hospital of Central Theater Command, Wuhan 430070, China
| | - Jishi Ye
- Department of Pain, Renmin Hospital of Wuhan University, Wuhan 430060, China
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Chauhan G, Srinivasan SK, Khanduja S. Dorsal Root Ganglion Stimulation Therapy for Refractory Idiopathic Pudendal Neuralgia. Cureus 2023; 15:e34681. [PMID: 36909041 PMCID: PMC9994636 DOI: 10.7759/cureus.34681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
Dorsal root ganglion stimulation is a relatively new treatment option for chronic pain conditions such as pudendal neuralgia, which is a chronic pain condition affecting the pudendal nerve in the pelvic region. Pudendal neuralgia is a debilitating condition that can significantly affect the patient's quality of life. In dorsal root ganglion stimulation, a small device is implanted that delivers electrical impulses to the dorsal root ganglion to modulate pain signals coming from the pudendal nerve. The procedure is considered investigational and has been investigated in case series and case reports with promising results. However, more research is needed to fully understand its safety and effectiveness. This case report highlights the potential of dorsal root ganglion stimulation as a treatment option for pudendal neuralgia and the need for further research to establish it as a standard treatment option.
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Affiliation(s)
- Gaurav Chauhan
- Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, USA
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Cain A, Carter K, Salazar C, Young A. When and How to Utilize Pudendal Nerve Blocks for Treatment of Pudendal Neuralgia. Clin Obstet Gynecol 2022; 65:686-698. [PMID: 35703212 DOI: 10.1097/grf.0000000000000715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Chronic pelvic pain is a common cause of pain in reproductive age women with debilitating consequences for affected women's health and quality of life. Treatment providers must be well versed in all treatment options for these patients, understanding the overlap in the management and treatment of chronic pelvic pain caused by pudendal neuralgia, myofascial pelvic pain, and vulvodynia. Pudendal blocks are a simple and quick procedure that can be performed in the office and often helps improve all the above conditions when used along with other treatment options. We review the anatomy and methodology on when and how to perform pudendal blocks in the office to better inform the general gynecologist on how to implement offering this treatment in the outpatient clinical setting.
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Affiliation(s)
- Abigail Cain
- The Dell Medical School at The University of Texas at Austin, Austin, Texas
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Jottard K, Bonnet P, Thill V, Ploteau S, de Wachter S. Diagnosis and treatment of pudendal and inferior cluneal nerve entrapment syndrome: a narrative review. Acta Chir Belg 2022; 122:379-389. [PMID: 36074049 DOI: 10.1080/00015458.2022.2123138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
AIM Pudendal and inferior cluneal nerve entrapment can cause a neuropathic pain syndrome in the sensitive areas innervated by these nerves. Diagnosis is challenging and patients often suffer several years before diagnosis is made. The purpose of the review was to inform healthcare workers about this disease and to provide a basis of anatomy and physiopathology, to inform about diagnostic tools and invasive or non-invasive treatment modalities and outcome. METHODS A description of pudendal and inferior cluneal nerve anatomy is given. Physiopathology for entrapment is explained. Diagnostic criteria are described, and all non-invasive and invasive treatment options are discussed. RESULTS The Nantes criteria offer a solid basis for diagnosing this rare condition. Treatment should be offered in a pluri-disciplinary setting and consists of avoidance of painful stimuli, physiotherapy, psychotherapy, pharmacological treatment led by tricyclic antidepressants and anticonvulsants. Nerve blocks are efficient at short term and serve mainly as a diagnostic tool. Pulsed radiofrequency (PRF) is described as a successful treatment option for pudendal neuralgia in patients non-responding to non-invasive treatment. If all other treatments fail, surgery can be offered. Different surgical procedures exist but only the open transgluteal approach has proven its efficacy compared to medical treatment. The minimal-invasive ENTRAMI technique offers the possibility to combine nerve release with pudendal neuromodulation. CONCLUSIONS Pudendal and inferior cluneal nerve entrapment syndrome are a challenge not only for diagnosis but also for treatment. Different non-invasive and invasive treatment options exist and should be offered in a pluri-disciplinary setting.
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Affiliation(s)
- Katleen Jottard
- Department of Surgery, CHU Brugmann, Arthur Van Gehuchtenplaats 4, 1020 Brussels, Belgium
| | - Pierre Bonnet
- Department of Urology and Department of Anatomy, CHU Sart-Tilman, Liège, Belgium
| | - Viviane Thill
- Department of Surgery, CHU Brugmann, Arthur Van Gehuchtenplaats 4, 1020 Brussels, Belgium
| | - Stephane Ploteau
- Department of Gynecology and Obstetrics, Center Hospitalier Universitaire, Nantes, France
| | - Stefan de Wachter
- Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
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