Evaluation of diagnostic accuracy of Colour Duplex Scanning, compared to electroneuromyography, diagnostic score and surgical outcomes, in Pudendal Neuralgia by entrapment: A prospective study on 96 patients

Abstract

The objective of our study is to evaluate the detection capacity of Colour Duplex Scanning (CDS) in helping to diagnose Pudendal Neuralgia (PNa) by Pudendal Nerve Entrapment (PNE). This technique is being compared to complete Neurological Criteria (NC) based on Diagnostic Score (DS) and Electroneuromyography (ENMG) and secondly, to the results of surgery. This is a prospective study, on a consecutive series of 96 unselected patients evaluated by both CDS and NC. The CDS examinations were performed by the same operator who was unaware of the NC. The DS and the ENMG were read by a practitioner who was unaware of the CDS findings. The Peak Systolic Velocity (PSV) and the Systolic Ascension Time (AT) were the vascular criteria. Inadequate examinations were neither repeated nor removed from the analysis. Of 166 Internal Pudendal Arteries (IPAs) explored by CDS, 163 were visualised on their whole course, leading to a 98% feasibility. Of the 67 PNE identified by NC, 60 cases of Pudendal Vascular Entrapment (PVE) were detected by CDS, leading to a 89.6% sensitivity and a 67.4% specificity. Currently, there is no gold standard that can diagnose PNa by PNE with certainty. CDS is a non-invasive technique, demonstrating high diagnostic value to confirm PNE. In this study, we determined a new objective diagnostic criterion, the Pudendal Artery Ratio (PAR), which is very strong at diagnosing PNE but needs to be validated by further studies.

Proctalgia in Pudendal Nerve Entrapment Syndrome: A Pathology to Know

“…In our sample, Computed Tomography (CT) scan was performed in 14 cases, a Magnetic Resonance (MR) scan in all cases, and endorectal ultrasound in 49 patients. Mollo [21] used color Doppler of the internal pudendal artery to support the diagnosis.…”

Actualización del síndrome de atrapamiento del nervio pudendo: enfoque anatómico-quirúrgico, diagnóstico y terapéutico

“…Mollo et al publican un interesante estudio donde comparan la efectividad de del ecodoppler por vía endocavitaria y las tradicionales pruebas electromiográ ficas y electroneurográ ficas , criterios diagnó sticos y resultados quirú rgicos 29 .…”

Free Communications

“…Clinical examination rarely elicits specific signs with recto-vaginal nodules only being palpated in 43% of women with deep infiltrating disease. (6) In a cohort of 400 women, data on pelvic pain symptoms and findings on clinical examination were analysed to determine association with findings at laparoscopic assessment. A model was developed using stepwise logistic regression, to predict whether women had endometriosis and specifically whether women had deep infiltrating disease.…”

“…Pudendal nerve surgery should not have any other aim than a complete decompression of the nerve in order to obtain a significant reducing of the pressure in the Pudendal canal. Reaching this « high pressure enclosure » is possible via a superior route: the laparoscopic approach [1], an inferior route: the perineal approach described by Shafik [2,3], a posterior route: the trans-gluteal (TG) approach described by Robert [4] or an endo-pelvic route: The trans-ischio-rectal (TIR) approach [5,6] under retroperitoneoscopic control.…”

“…One patient died after reoperation (laparoscopy converted to open surgery) to repair a digestive fistula. Mean hospitalization time was 6.5 days [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. 72% of the patients were discharged directly home.…”