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Aoun F, Alkassis M, Tayeh GA, Chebel JA, Semaan A, Sarkis J, Mansour R, Mjaess G, Albisinni S, Absil F, Bollens R, Roumeguère T. Sexual dysfunction due to pudendal neuralgia: a systematic review. Transl Androl Urol 2021; 10:2500-2511. [PMID: 34295736 PMCID: PMC8261452 DOI: 10.21037/tau-21-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/26/2021] [Indexed: 01/16/2023] Open
Abstract
Background The pudendal nerve is considered as the main nerve of sexuality. Pudendal neuralgia is an underdiagnosed disease in clinical practice. The aim of this systematic review is to highlight the role of pudendal neuralgia on sexual dysfunction in both sexes. Methods A PubMed search was performed using the following keywords: “Pudendal” AND “Sexual dysfunction” or “Erectile dysfunction” or “Ejaculation” or “Persistent sexual arousal” or “Dyspareunia” or “Vulvodynia”. The search involved patients having sexual dysfunction due to pudendal neuralgia. Treatment received was also reported. Results Five case series, seven cohort studies, two pilot studies, and three randomized clinical trials were included in this systematic review. Pudendal nerve and/or artery entrapment, or pudendal neuralgia, is a reversible cause of multiple sexual dysfunctions. Interventions such as anesthetic injections, neurolysis, and decompression are reported as potential treatment modalities. There are no studies describing the role of pudendal canal syndrome in the pathophysiology or treatment of delayed ejaculation or penile shortening. Discussion Pudendal neuralgia is an underestimated yet important cause of persistent genital arousal, erectile dysfunction (ED), premature ejaculation (PE), ejaculation pain, and vulvodynia. Physicians should be aware of this entity and examine the pudendal canal in such patients before concluding an idiopathic cause of sexual dysfunction.
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Affiliation(s)
- Fouad Aoun
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon.,Urology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Marwan Alkassis
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | - Georges Abi Tayeh
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | - Josselin Abi Chebel
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | - Albert Semaan
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | - Julien Sarkis
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | - Raymond Mansour
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | - Georges Mjaess
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon.,Urology Department, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Urology Department, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Fabienne Absil
- Urology department, Centre Hospitalier EpiCURA, Site de Ath, Ath, Belgium
| | - Renaud Bollens
- Urology department, Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
| | - Thierry Roumeguère
- Urology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.,Urology Department, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Aoun F, Mjaess G, Lilly E, Khalil N, Tayeh GA, Sarkis J, Mansour R, Alkassis M, Chebel R, Absil F, Bollens R. Is pudendal nerve entrapment a potential cause for weak ejaculation? Int J Impot Res 2021; 34:520-523. [PMID: 33972715 DOI: 10.1038/s41443-021-00443-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 11/09/2022]
Abstract
Ejaculatory dysfunction is one of the most common complaints of patients with sexual disorders. While it encompasses several ejaculatory disorders, weak ejaculation is seldom described in the literature. Since the pudendal nerve is the main nerve of ejaculation, we aim to hypothesize that pudendal nerve entrapment could be a cause of weak ejaculation, and that pudendal nerve release could contribute to the improvement of the ejaculatory stream. We presented two cases suffering from a weak ejaculatory stream and sensation of incomplete semen emptying, accompanied with clinical features of pudendal nerve entrapment. Both cases improved after pudendal nerve block and then laparoscopic transperitoneal pudendal release, with a sustained amelioration of the ejaculatory stream after 3 weeks of surgery. Pudendal canal entrapment is therefore a potentially curable cause for weak ejaculation.
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Affiliation(s)
- Fouad Aoun
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon. .,Department of Urology, Institut Jules Bordet, Brussels, Belgium.
| | - Georges Mjaess
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon
| | - Eddy Lilly
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon
| | - Nour Khalil
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon
| | | | - Julien Sarkis
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon
| | - Raymond Mansour
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon
| | - Marwan Alkassis
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon
| | - Roy Chebel
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon
| | - Fabienne Absil
- Department of Gynecology, EpiCura Hospital, Ath, Belgium
| | - Renaud Bollens
- Department of Urology, Wallonie Picarde Hospital, Tournai, Belgium
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Maggi M, Pirola GM, Absil F, De Plaen E, Mosca A, Salciccia S, Sciarra A, Bollens R. Erectile function recovery after laparoscopic decompression of pudendal artery and nerve: a documented case report. Cent European J Urol 2020; 73:569-571. [PMID: 33552586 PMCID: PMC7848823 DOI: 10.5173/ceju.2020.0088.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/30/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
The aim of this article is to report the effectiveness of laparoscopic decompression of pudendal artery (PA) and nerve for erectile dysfunction (ED) restoration. A 32-year-old man presented with a long-term complaint of ED not responsive to medical therapy. Endocrine screening and neurological evaluation did not show any abnormalities. Color Doppler ultrasound revealed the absence of blood flow in the right PA. After failure of conservative treatments and in accordance to the patient's desire, laparoscopic pudendal artery decompression was performed. The patient reported significant amelioration of ED one month after surgery. At 8-months follow-up, Doppler ultrasound showed complete revascularization of the right PA.
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Affiliation(s)
- Martina Maggi
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | | | - Fabienne Absil
- Department of Gynecology, Epicura Ath Hospital, Ath, Belgium
| | - Elea De Plaen
- Department of Urology, Wallonie Picarde Hospital, Tournai, Belgium
| | - Augusto Mosca
- Department of Urology, Frascati Hospital, Rome, Italy
| | - Stefano Salciccia
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Alessandro Sciarra
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Renaud Bollens
- Department of Urology, Wallonie Picarde Hospital, Tournai, Belgium.,Department of Urology, Université Nord de France, St. Phillibert Hospital, GHICL, Lille, France
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Aoun F, Mjaess G, Akl B, Nassar D, Kallas Chemaly A, Haydar A, Raad R, Absil F, Nemr E, Bollens R. Pudendal nerve release for lower urinary tract symptoms in young males. Low Urin Tract Symptoms 2020; 13:286-290. [DOI: 10.1111/luts.12368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/05/2020] [Accepted: 11/15/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Fouad Aoun
- Urology Department Institut Jules Bordet Brussels Belgium
- Urology Department Hotel‐Dieu de France, University of Saint Joseph Beirut Lebanon
| | - Georges Mjaess
- Urology Department Hotel‐Dieu de France, University of Saint Joseph Beirut Lebanon
| | - Bernard Akl
- Faculty of Medicine and Medical Sciences University of Balamand Beirut Lebanon
| | - Dany Nassar
- Urology Department Hotel‐Dieu de France, University of Saint Joseph Beirut Lebanon
| | | | - Asad Haydar
- Faculty of Medicine and Medical Sciences University of Balamand Beirut Lebanon
| | - Rami Raad
- Urology Department Rizk Hospital (Lebanese American University Medical Center) Beirut Lebanon
| | | | - Elie Nemr
- Urology Department Hotel‐Dieu de France, University of Saint Joseph Beirut Lebanon
| | - Renaud Bollens
- Urology Department Wallonie Picarde Hospital Tournai Belgium
- Department of Urology Université Nord de France, St Phillibert Hospital Lille France
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Aoun F, Semaan A, Mjaess G, Absil F, Bollens R. Pudendal nerve entrapment and recurrent urinary tract infection: Is there a link? Turk J Urol 2020; 46:410-411. [PMID: 32707031 DOI: 10.5152/tud.2020.20148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/23/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Fouad Aoun
- Department of Urology, Institut Jules Bordet, Brussels, Belgium.,Department of Urology, Hotel-Dieu de France, Beirut, Lebanon.,Université Saint Joseph, Beirut, Lebanon
| | - Albert Semaan
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon.,Université Saint Joseph, Beirut, Lebanon
| | | | | | - Renaud Bollens
- Department of Urology, Université Nord de France, St Phillibert Hospital, GHICL, Lille, France.,Wallonie Picarde Hospital, Tournai, Belgium
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Aoun F, Mjaess G, Assaf J, Chemaly AK, Younan T, Albisinni S, Absil F, Roumeguère T, Bollens R. Clinical effect of computed guided pudendal nerve block for patients with premature ejaculation: a pilot study. Scand J Urol 2020; 54:258-262. [PMID: 32476566 DOI: 10.1080/21681805.2020.1770855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Premature ejaculation has a complex etiology, and its pathophysiology is still unclear, with penile hypersensitivity being the most accepted hypothesis. The aim was to investigate the efficacy and safety of a computed tomography-guided pudendal nerve block at the level of the sacrospinous ligament and the Alcock's canal in patients with premature ejaculation refractory to conventional pharmacological treatment.Methods: This is a prospective pilot study involving five patients suffering from premature ejaculation refractory to standard treatment and clinical features of pudendal nerve entrapment. A CT-guided infiltration of ropivacaine and methylprednisone was done at the levels of sacrospinous ligament and Alcock's canal. Intra-vaginal ejaculatory latency time (IELT) was recorded several times for each patient before and after infiltration. International Index of Erectile Function (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT) and Sexual Quality of Life-Male version (SQoL-M) questionnaire were also evaluated before and after infiltration.Results: Overall IELT differed significantly before and after treatment (21.94 vs 215.42 s; p = 0.039). IIEF-5, PEDT and SQoL-M also differed significantly before and after treatment. No complications for the CT-guided infiltration were recorded.Conclusion: CT-guided pudendal nerve block at the sacrospinous ligament and the Alcock's canal was effective in improving premature ejaculation. Therefore, pudendal nerve entrapment may be a curable cause of sensory premature ejaculation.
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Affiliation(s)
- Fouad Aoun
- Urology Department, Institut Jules Bordet, Brussels, Belgium.,Hotel-Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | - Georges Mjaess
- Hotel-Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | - Joseph Assaf
- Hotel-Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | | | - Tonine Younan
- Hotel-Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | - Simone Albisinni
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Thierry Roumeguère
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Renaud Bollens
- Department of Urology, St Phillibert Hospital, GHICL, Université Nord de France, Lille, France.,Wallonie Picarde Hospital, Tournai, Belgium
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Aoun F, Mjaess G, Daher K, Sakr G, Chemaly AK, Salameh M, Albisinni S, Absil F, Roumeguere T, Bollens R. Laparoscopic treatment of pudendal nerve and artery entrapment improves erectile dysfunction in healthy young males. Int J Impot Res 2020; 33:1-5. [PMID: 32366984 DOI: 10.1038/s41443-020-0287-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/01/2020] [Accepted: 04/09/2020] [Indexed: 12/20/2022]
Abstract
Erectile dysfunction (ED) is increasingly becoming more common in young healthy males and is attributed mainly to psychogenic causes in these patients. Recent studies have reported that ED could be secondary to pudendal nerve or artery entrapment. This perspective assessed the efficacy of laparoscopic pudendal nerve and artery decompression in young patients suffering from refractory ED, associated to a pudendal nerve entrapment syndrome. After excluding patients with psychological ED and venous leakage, five young male patients with a history of both ED and pudendal nerve entrapment syndrome diagnosed based on the Nantes criteria were recruited. Pudendal nerve and artery release was performed using a laparoscopic transperitoneal approach. International Index for Erectile Function (IIEF-5) and erectile hardness score (EHS) improved significantly in all patients, 3 months after surgery. Pudendal nerve and artery entrapment could be therefore a reversible cause of ED in young healthy males, and its treatment by laparoscopic pudendal nerve and artery decompression seems to be safe and effective.
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Affiliation(s)
- Fouad Aoun
- Urology Department, Institut Jules Bordet, Brussels, Belgium. .,Hotel-Dieu de France, Université Saint Joseph, Beirut, Lebanon. .,Mount Lebanon Hospital, Beirut, Lebanon.
| | - Georges Mjaess
- Hotel-Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | - Karim Daher
- Rizk Hospital (LAU Medical Center), Beirut, Lebanon
| | | | - Anthony Kallas Chemaly
- Hotel-Dieu de France, Université Saint Joseph, Beirut, Lebanon.,Mount Lebanon Hospital, Beirut, Lebanon
| | | | - Simone Albisinni
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Thierry Roumeguere
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Renaud Bollens
- Department of Urology, Université Nord de France, St Phillibert Hospital, GHICL, Lille, France.,Wallonie Picarde Hospital, Tournai, Belgium
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