Estimate of the proportion of uncertain diagnoses of pudendal neuralgia in women with chronic pelvic‐perineal pain: A systematic review with a descriptive data synthesis

Abstract

Background There is a gap between pudendal neuralgia (PN) due to pudendal entrapment syndrome and PN without pudendal entrapment syndrome. The latter could have atypical symptoms. Aim Defining a rate of atypical PN from a clinical series of female patients with chronic pelvic‐perineal pain. Methods The atypical PN was defined as a pain not meeting clinical criteria for pudendal entrapment syndrome. The effect size was the rate of atypical PN. Such a rate was expected to be found among patients screened for enrollment in clinical series on pudendal neuropathic pain. A systematic search was performed looking for clinical series on PN. Studies must report information on female patients, pelvic‐perineal pain, at least a clinical criterion for diagnosing the pudendal neurogenic origin of pain, the proportion of patients with pain not meeting the clinical criterion/a for diagnosing the pudendal entrapment pain. Results From 2637 references, nine studies were included for qualitative analysis. Three of them were not suitable for data synthesis: one assessed the rate of PN after hip arthroscopy; second enrolled miscellaneous patients, a third investigated patients with gynecological diseases. Six studies involved patients with suspicion of pudendal entrapment symptoms (205 patients observed), allowing data synthesis. One of these series was judged as being of good quality. The overall rate of atypical PN is 0.013 (95% confidence interval, 0.008‐0.021), I2 0%. Further analysis suggests the risk of bias for all studies. Conclusions Atypical PN in females is low when clinical criteria for pudendal entrapment syndrome are applied.

Endoscopic trans gluteal minimal‐invasive approach for nerve liberation (ENTRAMI technique) in case of pudendal and/or cluneal neuralgia by entrapment: One‐year follow‐up

“…Until now only the Nantes criteria are considered as a golden standard in helping to diagnose this rare condition. 4,11,12 When diagnosis is suspected, treatment should be offered in a multidisciplinary setting to optimize treatment outcome. Behavioral therapy, physiotherapy, neuropathic pain drugs, pudendal and/or cluneal nerve infiltrations are such treatment options, but long term efficacy is disappointing for some.…”

When and How to Utilize Pudendal Nerve Blocks for Treatment of Pudendal Neuralgia

“…Findings of a recently published systematic review concluded that Nantes' criteria are the gold standard for diagnosing typical PN as well as PNE syndrome. 11 If 1 or more of the clinical essential Nantes' criteria are not met then atypical PN can be presumed, though this is thought to be low at ∼1% of patients. 11 There are 5 essential diagnostic criteria Often patients will report they do not tolerate tight clothing and can sit on the toilet seat without pain, but not on flat surfaces.…”

“…11 If 1 or more of the clinical essential Nantes' criteria are not met then atypical PN can be presumed, though this is thought to be low at ∼1% of patients. 11 There are 5 essential diagnostic criteria Often patients will report they do not tolerate tight clothing and can sit on the toilet seat without pain, but not on flat surfaces. Patients may also favor one side of their pelvis while sitting.…”

“…Findings of a recently published systematic review concluded that Nantes’ criteria are the gold standard for diagnosing typical PN as well as PNE syndrome 11. If 1 or more of the clinical essential Nantes’ criteria are not met then atypical PN can be presumed, though this is thought to be low at ∼1% of patients 11…”