Voiding Dysfunction Associated with Pudendal Nerve Entrapment

Marc Possover, A Forman, Marc Possover, A Forman

Abstract

Pudendal nerve entrapment (Alcock canal syndrome) is an uncommon source of chronic pelvic pain, in which the pudendal nerve is entrapped or compressed. Pain is located in the perineal, genital and perianal areas and is worsened by sitting. By simple entrapment of the PN without neurogenic damages, pain is usually isolated. In neurogenic damages to the PN, genito-anal numbness, fecal and/or urinary incontinence can occurred. PNE can be caused by obstetric traumas, scarring due to genitoanal surgeries (prolaps procedures!), accidents and surgical mishaps. Diagnosis is based on anamnesis, clinical examination including vaginal or rectal palpation of the pelvic nerves with selective nerve blockade. Pudendal pain non systematic mean PNE since other neuropathies may induce pudendal pain. So sacral radiculopathies (sacral nerves roots S#2-4) are underestimated etiologies frequently responsible for pudendal pain with irradiation in sacral dermatomes, bladder hypersensitivity or in neurogenic lesions, bladder retention.

References

    1. Reitz A, Schmid DM, Curt A, Knapp PA, Schurch B. Afferent fibers of the pudendal nerve modulate sympathetic neurons controlling the bladder neck. Neurourol Urodyn. 2003;22(6):597–601. doi: 10.1002/nau.10134.
    1. Roberts RO, Lieber MM, Bostwick DG, Jacobsen SJ. A review of clinical and pathological prostatitis syndromes. Urology. 1997;49:809–21. doi: 10.1016/S0090-4295(97)00235-5.
    1. Virseda Chamorro M, Salinas-Casdo J, Zarza-Lucianez D, Mendez-Rubio S, Pelaquim H, Esteban-Fuertes M. Participation of the pudendal innervation in the detrusor overactivity of the detrusor and in the overactive bladder syndrome. Actas Urol Esp. 2012;36(1):37–41. doi: 10.1016/j.acuroe.2011.07.004.
    1. Verdeja AM, Elkins TE, Odoi A, Gasser R, Lamoutte C. Transvagnal sacropsinous colpopexy: anatomic landmarks to be aware of to minimize complications. Am J Obstet Gynecol. 1995;173:1468–9. doi: 10.1016/0002-9378(95)90634-7.
    1. Debodinance P, Amblard J, Fatton B, Cosson M, Jacquetin B. The prosthetic kits in the prolapsed surgery: is it a gadget? J Gynecol Obstet Biol Reprod. 2007;36(3):267–75. doi: 10.1016/j.jgyn.2007.02.018.
    1. Possover M, Lemos N. Risks, symptoms, and management of pelvic nerve damage secondary to surgery for pelvic organ prolapse: a report of 95 cases. Int Urogynecol J. 2011;22(12):1485–90. doi: 10.1007/s00192-011-1539-4.
    1. Moosey JJ, et al. Conus medullaris nerve root avulsions. J Neurosurg. 1987;66:835–41. doi: 10.3171/jns.1987.66.6.0835.
    1. Possover M. New surgical evolutions in management of sacral radiculopathies. Surg Technol Int. 2010;19:123–8.
    1. Peng PW, Tumber PS. Ultrasound-guided interventional procedures for patients with chronic pelvic pain - a description of techniques and review of literature. Pain Physician. 2008;11(2):215–24.
    1. Robert MI, Brunet C, Faure A, Lehur PA, Labat JJ, Bensigignor M, et al. La chirurgie du nerf pudendal lors de certaines algies perineales: evolution et resultats. Chirurgie. 1993;119:535–9.
    1. Shafik A. Pudendal canal decompression in the treatment of idiopatic fecal incontinence. Dig Surg. 1992;9:265–71. doi: 10.1159/000172106.
    1. Possover M. Laparoscopic management of endopelvic etiologies of pudendal pain in 134 consecutive patients. J Urol. 2009;181:1732–6. doi: 10.1016/j.juro.2008.11.096.
    1. Melzack R, Wall P. Pain mechanisms: a new theory. Science. 1965;150:971–9. doi: 10.1126/science.150.3699.971.
    1. Alo KM, Holsheimer J. New trends in neuromodulation for the management of neuropathic pain. Neurosurgery. 2002;50:690–703. doi: 10.1097/00006123-200204000-00003.
    1. Peeren F, Hoebeke P, Everart K. Sacral nerve stimulation: interstim therapy. Expert rev Med Devices. 2005;2:253–8. doi: 10.1586/17434440.2.3.253.
    1. Bosch JLHR. The Bion device: a minimally invasive implantate ministimulator for pudendal nerve neuromodulation in patients with detrusor overactivity incontinence. Urol Clin N Am. 2005;32:109–12. doi: 10.1016/j.ucl.2004.09.003.
    1. Spinelli M, Malaguti S, Giardiello G, Lazzeri M, Tarantola J, Van Den Hombergh U. A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder: description of the method and preliminary data. Neurourol Urodyn. 2005;24(4):305–9. doi: 10.1002/nau.20118.
    1. Possover M. The laparoscopic implantation of neuroprothesis to the sacral plexus for therapy of neurogenic bladder dysfunctions after failure of percutaneous sacral nerve stimulation. Neuromodulation. 2010;13:141–4. doi: 10.1111/j.1525-1403.2009.00230.x.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться