Role of interventional radiology in pudendal neuralgia: a description of techniques and review of the literature

Fanucci, E; Manenti, Guglielmo; Ursone, Antonio; Fusco, Nicola; Mylonakou, I; D'Urso, S; Simonetti, G

doi:10.1007/s11547-009-0371-0

Cited by 38 publications

(21 citation statements)

References 21 publications

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“…Similar findings were obtained by Mc Donald and Spigos [43], but there were no long-term data. Those of Fannucci et al [44] agree with our results, in that infiltration is a safe treatment, obtaining a clinical effectiveness higher than ours (92% at 12 months).…”

Section: Discussionsupporting

confidence: 93%

Proctalgia in Pudendal Nerve Entrapment Syndrome: A Pathology to Know

Pascual¹,

Castro²,

Mir³

et al. 2017

Med Clin Rev

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Section: Discussionsupporting

confidence: 93%

Proctalgia in Pudendal Nerve Entrapment Syndrome: A Pathology to Know

Pascual¹,

Castro²,

Mir³

et al. 2017

Med Clin Rev

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“…We acknowledge that the majority of repeat injections that were initially negative were positive on second attempt, raising the likelihood of technical error in the procedure. Results of the present cohort of patients compare favourably to the efficacy rates seen in both magnetic resonance‐ and CT‐guided studies . Furthermore, although numbers in the present series are relatively small, subsequent operative success rates in our study often exceeded those of their image‐guided counterparts …”

Section: Discussionsupporting

confidence: 73%

“…The injection itself can be performed with or without the assistance from image guidance. Image guidance which includes magnetic resonance imaging, CT and ultrasound has been implemented in pudendal injections with varying forms of success . In our study, we performed pudendal nerve injections according to anatomical principles without the assistance of imaging.…”

Section: Discussionmentioning

confidence: 99%

Role of nerve block as a diagnostic tool in pudendal nerve entrapment

Dickson

Higgins

Sehgal

et al. 2019

ANZ Journal of Surgery

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Background: Pudendal nerve entrapment is a disabling condition which is difficult to diagnose and treat. Nantes criteria include the requirement of positive anaesthetic pudendal nerve block that is widely used to allow identification of patients likely to benefit from the definitive but invasive pudendal nerve release. This study aimed to determine if pudendal nerve blockade under general anaesthesia could diagnose and temporarily treat pudendal nerve entrapment in patients suffering from chronic pelvic/perineal pain and/or organ dysfunction. Methods: This retrospective analysis of a prospectively maintained database examined the outcomes of all recipients of diagnostic pudendal nerve block in a quaternary referral centre between 2012 and 2017. Primary outcome was relief of perineal pain (transient or permanent). Secondary outcomes were demographics, referral patterns for definitive procedure and complication rates. Statistical analysis was performed using SPSS v 24. Results: A total of 77 patients were included in the study. Mean age was 57.27 AE 13.55 years. Majority were females (n = 62, 80.5%). Relief of pain was experienced by 47 of 76 (68.1%) patients after initial injection. Complication rate of injection was 3.9% (n = 3) which in all cases was unilateral lower limb paraesthesia. Of the 37 patients (52.9%) referred, 20 underwent surgical decompression with 12 (60%) being successful. Conclusion: Pudendal nerve injection is a safe and simple procedure that can provide accurate diagnosis and transient relief from this chronic and debilitating problem. This technique helps to isolate patients suitable for pudendal nerve decompression which offers high success rates.

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“…Data published in the literature The literature [8][9][10][11][12][13] includes several publications reporting favourable results of corticosteroid infiltration in pudendal neuralgia. The percentage of patients who showed improvement (based on rarely specified criteria) ranged from 15 to 78% (Table S6).…”

Section: Main Findingsmentioning

confidence: 99%

Adding corticosteroids to the pudendal nerve block for pudendal neuralgia: a randomised, double‐blind, controlled trial

Riant

Lassaux

et al. 2016

BJOG

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ObjectiveTo compare the effect of corticosteroids combined with local anaesthetic versus local anaesthetic alone during infiltrations of the pudendal nerve for pudendal nerve entrapment.DesignRandomised, double‐blind, controlled trial.SettingMulticentre study.Population201 patients were included in the study, with a subgroup of 122 women.Methods CT‐guided pudendal nerve infiltrations were performed in the sacrospinous ligament and Alcock's canal. There were three study arms: patients in Arm A (n = 68) had local anaesthetic alone, those in Arm B (n = 66) had local anaesthetic plus corticosteroid and those in Arm C (n = 67) local anaesthetic plus corticosteroid with a large volume of normal saline.Main outcome measuresThe primary end‐point was the pain intensity score at 3 months. Patients were regarded as responders (at least a 30‐point improvement on a 100‐point visual analogue scale of mean maximum pain over a 2‐week period) or nonresponders.ResultsThree months’ postinfiltration, 11.8% of patients in the local anaesthetic only arm (Arm A) were responders versus 14.3% in the local anaesthetic plus corticosteroid arms (Arms B and C). This difference was not statistically significant (P = 0.62). No statistically significant difference was observed in the female subgroup between Arm A and Arms B and C (P = 0.09). No significant difference was detected for the various pain assessment procedures, functional criteria or quality‐of‐life criteria.ConclusionsCorticosteroids provide no additional therapeutic benefits compared with local anaesthetic and should therefore no longer be used.Tweetable abstractSteroid infiltrations do not improve the results of local anaesthetic infiltrations in pudendal neuralgia.

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Role of interventional radiology in pudendal neuralgia: a description of techniques and review of the literature

Abstract: In pudendal nerve entrapment, CT-guided perineural injection in the anatomical sites of nerve impingement is a safe and reproducible treatment with a clinical efficacy of 92% at 12 months.

Cited by 38 publications

References 21 publications

Proctalgia in Pudendal Nerve Entrapment Syndrome: A Pathology to Know

Proctalgia in Pudendal Nerve Entrapment Syndrome: A Pathology to Know

Role of nerve block as a diagnostic tool in pudendal nerve entrapment

Adding corticosteroids to the pudendal nerve block for pudendal neuralgia: a randomised, double‐blind, controlled trial

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