Bloqueos Nerviosos. Bases Anatómicas del Dolor Somático Abdomino-Pélvico / Nerve Blocks. Anatomy of the Somatic Innervation of the Abdomino-Pelvic Cavity

El dolor abdominal es una de las sintomatologías que afectan con frecuencia la cavidad abdomino-pélvica. Dicha cavidad posee una inervación somática en la que intervienen del séptimo a doceavo nervios intercostales, ramos colaterales y terminales del plexo lumbar y el nervio pudendo; siendo objetivo de este trabajo la descripción anatómica del dolor abdominopélvico a través del plexo lumbar, nervios intercostales y nervio pudendo, sus diferentes patrones y variaciones de conformación, y las implicancias de éstas últimas en las distintas maniobras clínico-quirúrgicas. Se realizó un estudio descriptivo, observacional y morfométrico de la inervación somática de la cavidad abdomino-pélvica, en 50 preparaciones cadavéricas, fijadas en solución de formaldehído, de la Tercera Cátedra de Anatomía, Facultad de Medicina, Universidad de Buenos Aires, entre Agosto/2017-Diciembre/2019. La descripción clásica del plexo lumbar se encontró en 35 casos; la presencia del nervio femoral accesorio en ningún caso; así como también la ausencia del nervio iliohipogástrico en ningún caso; el nervio obturador accesorio se halló en 2 casos; el nervio genitofemoral dividiéndose dentro de la masa muscular del psoas mayor en 6 casos; el nervio cutáneo femoral lateral emergiendo únicamente de la segunda raíz lumbar en 6 casos y por último se encontró la presencia de un ramo del nervio obturador uniéndose al tronco lumbosacro en un caso. Los nervios intercostales y el nervio pudendo presentaron una disposición clásica en todos los casos analizados. Es esencial un adecuado conocimiento y descripción del plexo lumbar, nervios intercostales y nervio pudendo para un adecuado abordaje de la cavidad abdomino-pélvica en los bloqueos nerviosos.

SUMMARY: Abdominal pain is one of the symptoms that affect the abdominal-pelvic cavity. The abdominal-pelvic cavity has a somatic innervation involving the seventh to twelfth intercostal nerves, collateral and terminal branches of the lumbar plexus and the pudendal nerve. The objective of this work is the description of the lumbar plexus, intercostal nerves and pudendal nerve, its different patterns and structure variations, as well as its implications during pain management in patients. A descriptive, observational, and morphometric study of patterns and structure variations of the lumbar plexus, intercostal nerves and pudendal nerve was conducted in 50 formalin-fixed cadaveric dissections of the Third Chair of Anatomy at the School of Medicine in the Universidad de Buenos Aires from August 2017 to December/2019. The standard description of the lumbar plexus was found in 35 cases; accessory femoral nerve was not present in any of the cases; absence of the iliohipogastric nerve was also not found in any case, while the accessory obturating nerve was found in 2 cases; genitofemoral nerve dividing within the muscle mass of psoas in 6 cases; lateral femoral cutaneous nerve emerging only from the second lumbar root in 6 cases and finally, presence of a branch of the obturating nerve was found joining the lumbosacral trunk in one case. The pudendal and intercostal nerve patterns presented a typical pathway in all cases. Adequate knowledge and description of the lumbar plexus, intercostal nerves and pudendal nerve is essential for an adequate approach of the abdominal-pelvic cavity in nerve blocks.

The Effect of Adjuvant Pudendal Nerve Block in Post-Operative Pain Following Perianal Surgery for Non Suppurative Conditions.

Background: Surgical management of non-suppurative perianal conditions are associated with intense pain in the postoperative period. Day case surgeries are often not possible for such conditions due to the need for post operative analgesia. The addition of pudendal nerve block lessens the post operative pain and hence avoids the need for opioids and its side effects. Aim: To assess the effectiveness of Pudendal nerve block in post -operative pain following perianal surgery for non suppurative conditions. Methods and material: Prospective cohort study. Patients undergoing surgical modality for anal fissures and hemorrhoids are divided into two groups. Group A receives pudendal nerve block (local infiltration) along with Spinal anaesthesia. Group B receives only Spinal anaesthesia. Post-operative pain (visual analog score) was analyzed and results compared. Results: It was found that there was a statistically significant association between being given pudendal nerve block and the need for analgesics post operatively. Conclusion: Pudendal block with local infiltration, if properly administered has excellent results with regard to patient’s pain tolerance, postoperative outcome and probable cost effectiveness. We conclude that the addition of pudendal nerve block with spinal anesthesia for non-suppurative anal conditions reduces the post operative pain and avoids the need for opioids and its side effects. It is safe and effective and it lessens the duration of hospital stay there by providing the patient with less stress of staying in the hospital for longer periods.

Toward the first definition of taste rosea in female breasts: histological analysis / La primera definición del sabor rosea en mamas femeninas: análisis histológico

Although various neuropsychochemical theories have been established about why breastfeeding mothers feel hedonic sensation, the underlying neural mechanism has not been adequately clarified. We aimed to investigate if there is hedonic sensation-initiated taste-bud like structures stimulated by sugars in the milk-secreting lactiferous ducts of mammary glands of breastfeeding female rats. In this study, twenty-two female rats were chosen which six of the virgin (n=6), six of pregnant (n=6) and ten of breastfeeding (n=10). We examined lactiferous ducts/nipples of mammary glands of all animals. They were sacrificed following intracardiac formalin injection, and their breast tissues were removed with covering tissues and fixed with 10 % of formalin solution. After current histological procedures, the tissues were examined by light microscope to assess taste-bud like structures, and their numerical densities were calculated by using stereological methods. Results were analyzed statistically. Taste-buds like structures with neuron-like appendages at the apical ends were discovered in lactiferous ducts. The taste rosea numbers were estimated as 3±1/mm3 in virgins, 167±27/mm3 in pregnant and 375±63/mm3 in breastfeeding animals. The taste rosea numbers were greater in breastfeeding rats than those of virgins and pregnant rats. They named as taste rosea resembling flower bucket which has not been mentioned in the literature so far.

Existen varias teorías neuropsicoquímicas, referente a la sensación hedónica que sienten las mujeres al amamantar, y el mecanismo neural subyacente. No obstante, estas aún no se aclaran adecuadamente. El objetivo de este estudio, fue investigar si existen estructuras hedónicas iniciadas por la sensación gustativa estimuladas por los azúcares en los conductos mamarios secretores de leche, de las glándulas mamarias de las ratas durante el período de lactancia. En este estudio, se eligieron 22 ratas hembras, seis de estas no preñadas como grupo control, seis preñadas y diez en período de lactancia. Examinamos los conductos lactíferos / pezones de las glándulas mamarias de los tres grupos. Los animales fueron sacrificados por medio de inyección intracardíaca de formalina. El tejido mamario se fijó en solución de formalina al 10 %. La muestras histólogicas fueron examinadas a través microscopía óptica con la finalidad de evaluar estructuras con características morfológicas similares a las papilas gustativas. Su densidad de número se calculó utilizando métodos estereológicos. Los resultados fueron analizados estadísticamente. En los conductos mamarios se observaron dos estructuras con con características morfológicas tipo papilas gustativas con apéndices neuronales en los extremos apicales. Los números se estimaron en 3±1/mm3 en el grupo control, 167±27/mm3 en gestantes y 375±63/mm3 en animales lactantes. El número de estructuras características morfológicas similares a las papilas gustativas fue mayor en las ratas amamantando que en el grupo control y que en las ratas preñadas. Conocido como sabor rosea debido a que se asemeja a un ramo de flores, lo que hasta ahora no se ha mencionado en la literatura.

Defective Conduction of Anorectal Afferents Is a Very Prevalent Pathophysiological Factor Associated to Fecal Incontinence in Women

BACKGROUND/AIMS: Fecal incontinence (FI) is a prevalent condition among women. While biomechanical motor components have been thoroughly researched, anorectal sensory aspects are less known. We studied the pathophysiology of FI in community-dwelling women, specifically, the conduction through efferent/afferent neural pathways. METHODS: A cross-sectional study was conducted on 175 women with FI and 19 healthy volunteers. The functional/structural study included anorectal manometry/endoanal ultrasound. Neurophysiological studies including pudendal nerve terminal motor latency (PNTML) and sensory-evoked-potentials to anal/rectal stimulation (ASEP/RSEP) were conducted on all healthy volunteers and on 2 subgroups of 42 and 38 patients, respectively. RESULTS: The main conditions associated with FI were childbirth (79.00%) and coloproctological surgery (37.10%). Cleveland score was 11.39 ± 4.09. Anorectal manometry showed external anal sphincter and internal anal sphincter insufficiency in 82.85% and 44.00%, respectively. Sensitivity to rectal distension was impaired in 27.42%. Endoanal ultrasound showed tears in external anal sphincter (60.57%) and internal anal sphincter disruptions (34.80%). Abnormal anorectal sensory conduction was evidenced through ASEP and RSEP in 63.16% and 50.00% of patients, respectively, alongside reduced activation of brain cortex to anorectal stimulation. In contrast, PNTML was delayed in only 33.30%. Stools were loose/very loose in 56.70% of patients. CONCLUSIONS: Pathophysiology of FI in women is mainly associated with mechanical sphincter dysfunctions related to either muscle damage or, to a lesser extent, impaired efferent conduction at pudendal nerves. Impaired conduction through afferent anorectal pathways is also very prevalent in women with FI and may play an important role as a pathophysiological factor and as a potential therapeutic target.

Comparison of Ultrasound-Guided Transgluteal and Finger-Guided Transvaginal Pudendal Nerve Block Techniques: Which One is More Effective? / 대한배뇨장애요실금학회지

PURPOSE: Pudendal neuralgia (PN) is a painful and disabling condition, which reduces the quality of life as well. Pudendal nerve infiltrations are essential for the diagnosis and the management of PN. The purpose of this study was to compare the effectiveness of finger-guided transvaginal pudendal nerve infiltration (TV-PNI) technique and the ultrasound-guided transgluteal pudendal nerve infiltration (TG-PNI) technique.METHODS: Forty patients who underwent PNI for the diagnosis of PN were evaluated. Thirty-five of these 40 patients, who were diagnosed as PN, underwent a total of 70 further unilateral PNI. All the patients underwent PNI for twice after the first diagnostic PNI, 1 week apart.RESULTS: In the ultrasound (US)-guided TG-PNI group, the success rate was 68.8% (11 of 16) in both “pain in the sitting position” and “pain in the region from the anus to the clitoris.” The success rate of blocks in the US-guided TG-PNI group was 75% (12 of 16) in terms of pain during/after intercourse. In the finger-guided TV-PNI group, the success rate was 84.2% in both “pain in the sitting position” and “pain in the region from the anus to the clitoris.” The success rate of blocks in the fingerguided TV-PNI group was 89.5% (17 of 19) in terms of pain during/after intercourse. There was no statistically significant difference in the success rate of the 3 assessed conditions between the 2 groups (P>0.05).CONCLUSIONS: The TV-PNI may be an alternative to US-guidance technique as a safe, simple, effective approach in pudendal nerve blocks.

Report of an inferior rectal nerve variant arising from the S3 ventral ramus / 대한해부학회지

In surgical approaches to the perineum in general and anal region specifically, considering the possible variations of the inferior rectal nerve is important for the surgeon. Normally, the inferior rectal nerve originates as a branch of the pudendal nerve. However, during routine dissection, a variant of the inferior rectal nerve was found where it arose directly from the third sacral nerve ventral ramus (S3). Many cases have described the inferior rectal nerve arising independently from the sacral plexus, most commonly from the fourth sacral nerve root (S4); however, few cases have reported the inferior rectal nerve arising from S3. Herein, we describe a variant of the inferior rectal nerve in which the nerve arises independently from the sacral plexus.

Radiofrecuencia pulsada para tratamiento de neuralgia de nervio pudendo bajo guía ultrasonográfica: a propósito de dos casos / Radiofrequency pulsed for treatment of neuralgia of nervio pudendo under ultrasonographic guide: a purpose of two cases

INTRODUCCIÓN: La neuralgia de nervio pudendo (NNP) se presenta como un dolor neuropático intenso, ardiente y difuso en la zona perineal, acompañado en ocasiones de hipoestesia, alodinia, hiperalgesia, sensibilidad dérmica, parestesia y entumecimiento que empeora el dolor en sedestación. Es un síndrome subdiagnosticado que, en ocasiones, se presenta refractario al tratamiento farmacológico y fisiátrico. OBJETIVOS: Evaluar la eficacia de la radiofrecuencia pulsada (RFP) guiada por ultrasonido para el tratamiento de dolor crónico, realizada a dos pacientes con NNP refractarios a tratamiento conservador. MATERIALES Y MÉTODO: Siendo positivo el bloqueo diagnóstico realizado con 0,5-1 ml de lidocaína al 2 por ciento, se practicó RFP bajo guía ecográfica a 2 pacientes (1 femenina de 36 años y 1 masculino de 54 años) con diagnóstico de NNP (según criterio de Nantes) y se realizó seguimiento a 1 semana y a 1 mes del procedimiento, observando la evolución del dolor mediante la utilización de la escala visual análoga (EVA), calidad de vida según lo informado en consulta y evolución en la ingesta y dosis de medicamentos. RESULTADOS: Luego del procedimiento la reducción del dolor fue significativa en ambos casos, en la paciente 1 (femenina) la EVA pasó de 10/10 (preoperatorio) a 1/10 a una semana del procedimiento y desapareció por completo al mes, retirándose en su totalidad la medicación indicada para la NNP. Asimismo, la paciente manifestó mejora en la calidad de vida, al no tener ya dolor durante el coito. Por su parte, en el paciente 2 (masculino), el dolor se redujo en un 50 por ciento registrándose un EVA que pasó de 8/10 (preoperatorio) a 4/10 a la semana y al mes de realizado el procedimiento. En su caso, al no haber desaparecido por completo el dolor, continuó tomando la medicación indicada (duloxetina 30 mg) y refirió poder sentarse con comodidad, ya sin el dolor intenso que lo aquejaba en esta posición, pudiendo incluso realizar un viaje de larga distancia. DISCUSIÓN: La RFP es un procedimiento efectivo en aquellos pacientes correctamente diagnosticados de neuralgia del nervio pudendo según el criterio de Nantes, refractarios a tratamiento farmacológico y/o fisioterápico, practicada por profesionales con entrenamiento y/o experiencia en la técnica de radiofrecuencia pulsada así como en el manejo de ultrasonido para ubicar sonoanatómicamente el nervio pudendo, en un ámbito seguro para la realización del procedimiento.

INTRODUCTION: The pudendal neuralgia is presented as a neurophatic pain that is intense, burning, difusse in the perineal area, sometimes accompanied by hypoesthesia, allodynia, hyperalgesia, dermal sensitivity, paresthesia and numbness that worsens by sitting. It ́s a syndrome underdiagnosed that can sometimes be refractory to traditional management like pharmacological or physical therapy. OBJECTIVES: Test the effectiveness of pulsed radiofrecuency by ultrasound-guided treatment of cronic pain done to two patients with pudendal neuralgia that were refractory to the conservative treatment. MATERIALS AND METHODS: As the diagnostic block done with 0,5-1 ml with 2 percent of lidocaine gave a positive outcome, we perform a pulsed radiofrecuency by an ultrasound-guide to two patients (36 year old female and a 54 year old male) with pudendal neuralgia diagnosted according to Nantes criteria and a tracing of 1 week and 1 month of the procedure was performed observing the pain evolution through visual analogue scale, quality of life according to the as reported in consultation and evolution in the intake and dose of medications. RESULTS: The reduction of pain was significant in both cases, in patient 1 (female) the VAS went from 10/10 (preoperative) to 1/10 to a week of the procedure and disappeared completely to 1 month, with the medicines completely withdrawn indicated for pudendal neuralgia. The female patient (1) showed improvement in the quality of life by not having pain during intercourse. On the other hand, in patient 2 (male), the pain was reduced by 50 percent, registering an EVA that went from 8/10 (preoperative) to 4/10 to 1 week and 1 month after the procedure was performed. In his case, since the pain had not completely disappeared, he continued to take the indicated medication (duloxetine 30 mg) and referred to be able to sit comfortably, without the intense pain that afflicted him in this position, even being able to travel long distances. DISCUSSION: Pulsed radiofrequency is an effective procedure in those patients correctly diagnosed with pudendal neuralgia according to the Nantes criterion, refractory to pharmacological and / or physiotherapeutic treatment, practiced by professionals with training and / or experience in the pulsed radiofrequency technique as well as in the management of ultrasound to locate the pudendal nerve sonoanatomically, in a safe environment for carrying out the procedure.

Effectiveness of two different acupuncture strategies in patients with vulvodynia: Study protocol for a pilot pragmatic controlled trial / 中西医结合学报

<p><b>BACKGROUND</b>Vulvodynia, or vulvar pain, is a common condition in women; however, there are few evidence-based clinical trials evaluating nonpharmacological therapies for this condition. Acupuncture is one complementary and integrative medicine therapy used by some patients with vulvodynia. This study evaluates two different acupuncture strategies for the treatment of vulvodynia and aims to evaluate whether either of the acupuncture protocols reduces vulvar pain, pain duration or pain with intercourse. The study also examines how long the effect of acupuncture lasts in women with vulvodynia.</p><p><b>METHODS/DESIGN</b>The study is designed as a randomized controlled trial, focused on two acupuncture protocols. Fifty-one patients who have had vulvodynia for more than 3 months will be recruited. Among them, 34 patients will be randomized into Groups 1a and 1b; those who are unwilling to receive acupuncture will be recruited into the standard care group (Group 2). Patients in Group 1a will have acupuncture focused on the points in the pudendal nerve distribution area, while patients in Group 1b will receive acupuncture focused on traditional (distal) meridian points. Patients in Group 2 will receive routine conventional treatments, such as using pain medications, local injections and physical therapies or other nonsurgical procedures. Acupuncture will last 45 min per session, once or twice a week for 6 weeks. The primary outcome measurement will be objective pain intensity, using the cotton swab test. The secondary outcome measurement will be subjective patient self-reported pain intensity, which will be conducted before cotton swab test. Pain intensities will be measured by an 11-point Numeric Pain Rating Scale. Pain duration and pain score during intercourse are recorded. Local muscle tension, tenderness and trigger points (Ashi points) are also recorded. All measurements will be recorded at baseline (before the treatment), at the end of each week during treatment and at the end of the 6 weeks. Follow-up will be done 6 weeks following the last treatment.</p><p><b>DISCUSSION</b>Results of this trial will provide preliminary data on whether acupuncture provides better outcomes than nonacupuncture treatments, i.e., standard care, and whether acupuncture focused on the points in pudendal nerve distribution, near the pain area, has better results than traditional acupuncture focused on distal meridian points for vulvodynia.</p><p><b>TRIAL REGISTRATION</b>Clinicaltrials.gov: NCT03481621. Register: March 29, 2018.</p>

Multimodal therapeutic approach of vaginismus: an innovative approach through trigger point infiltration and pulsed radiofrequency of the pudendal nerve / Terapêutica multimodal do vaginismo: abordagem inovadora por meio de infiltração de pontos gatilho e radiofrequência pulsada do nervo pudendo

Abstract Vaginismus is a poorly understood disorder, characterized by an involuntary muscular spasm of the pelvic floor muscles and outer third of the vagina during intercourse attempt, which results in aversion to penetration. It is reported to affect 1-7% of women worldwide. With this report the authors aim to describe the case of a young patient with vaginismus in whom techniques usually from the chronic pain domain were used as part of her multimodal therapeutic regimen.

Resumo O vaginismo é uma doença pouco compreendida que se caracteriza por uma contração muscular involuntária dos músculos do pavimento pélvico e do terço externo da vagina durante as tentativas de intercurso sexual, o que resulta em aversão à penetração. Estima-se que possa afetar entre 1%-7% da população feminina mundial. Com este relato os autores pretendem apresentar o caso de uma paciente jovem com vaginismo na qual foram usadas técnicas habitualmente do domínio da medicina da dor crônica como parte do seu esquema terapêutico multimodal.

Anestesia regional guiada por ultrasonido en territorio del nervio pudendo / Regional anesthesia guided by ultrasound in the pudendal nerve territory

Abstract Introduction: Pudendal nerve blocks have a wide range of clinical applications for the management of acute post-operative pain in urologic, gynecological surgery, in coloproctology, as well as in pain medicine for differential diagnosis, and for the management of pudendal neuropathies. However, despite its benefits it is infrequently used. Objective: To perform a detailed description of the most recent ultrasound-guided techniques with the aim of encouraging safe and reproducible learning. Materials and methods: We have performed a broad, non-systematic review of the literature through Medline, Embase and Science Direct between 1985 and 2016, to evaluate the most relevant articles, using the following key words: pudendal nerve anatomy, pudendal nerve, pudendal nerve blocks, pudendal nerve ultrasound, pudendal neuralgia, nerve entrapment, chronic pain, Alcock canal, and pelvic pain. The search was limited to articles published in Spanish, English and French. Results: Recent descriptions were found of a large number of anatomic variants, which are described in detail and shown in graphic documents in order to facilitate the sonoanatomic correlation of nerve location as a guide for the performance of the pudendal nerve block through the different approaches. Conclusions: The deep and detailed knowledge of the anatomy of the pudendal nerve and its variations is essential for the realization of Regional Anesthesia techniques guided by images. These promising techniques should continue to be evaluated with clinical studies.

Resumen Introducción: Los bloqueos del nervio pudendo poseen un amplio rango de utilidades clínicas en el manejo agudo de dolor POP en cirugía urológica, ginecológica, en coloproctología, así como en medicina del dolor en diagnóstico diferencial y manejo de las neuropatías del nervio pudendo. Sin embargo, su aplicación es relativamente infrecuente a pesar de los beneficios. Objetivo: Realizar una descripción detallada de las técnicas más recientes guiadas por ultra-sonografía con el objeto de motivar su aprendizaje de una manera segura y reproducible. Materiales y métodos: Se realizó una revisión amplia, no sistemática de la literatura a través de Medline, Embase y Science Direct desde 1985 hasta 2016, evaluando los artículos más relevantes, utilizando las palabras clave: anatomía del nervio pudendo, nervio pudendo, bloqueos del nervio pudendo, ultrasonido del nervio pudendo, neuralgia del pudendo, atrapamiento nervioso, dolor crónico, canal de Alcock y dolor pélvico. La búsqueda se limitó a artículos publicados en español, inglés y francés. Resultados: Se encontraron recientes descripciones de una gran cantidad de variantes anatómicas, que se describen en detalle y muestran en documentos gráficos con el propósito de facilitar la correlación sonoanatómica de la localización del nervio como guía para la realización de bloqueos de nervio pudendo a través de los diferentes abordajes. Conclusiones: El conocimiento profundo y detallado de la anatomía del nervio pudendo y sus variaciones es esencial para la realización de técnicas de anestesia regional guiada por imágenes. Estas técnicas promisorias deben continuar evaluándose con estudios clínicos.

Changes of Pudendal Nerve Terminal Movement Latency and Anorectal Function in Rectal Prolapsed Patients / 中山大学学报(医学科学版)

[Objectives]To evaluate the change of anorectal function in patients with rectal prolapsed by water perfusion anorec?tal manometry and pelvic floor electromyography.[Methods]A total of 60 patients with rectal prolapsed were enrolled in this study, the analgesic parameters included resting sphincter pressures, squeeze sphincter pressures, length of the anal canal and rectal sensa?tion, the results were compared with the parameters of normal population. Twenty of which completed pelvic floor electromyography ex?amination, analyzed the changes of pudendal nerve terminal movement latency (PNTML).[Results]The resting sphincter pressures, squeeze sphincter pressures of patients were lower than the normal population;The length of anal canal was shortened;The first sensa?tion and the first defecation threshold were higher than those of normal people, There was no significant change in the maximum tolera?ble threshold of rectum;pudendal nerve terminal movement latency extended more than 2.6 ms.[Conclusions]Anal resting stool and function of contraction weakened in patients of rectal prolapse, decreased sensitivity of rectal, pudendal nerve terminal movement laten?cy extended.

Value of pudendal nerve stimulation for predicting the stress urinary incontinence following pelvic prolapse surgery / 中华妇产科杂志

Objective To seek the predictive value of pudendal nerve function that need preventive anti-incontinence surgery at the same time following pelvic prolapse surgery in severe pelvic organ prolapse (POP) patients. Methods Seventy women completed this study from January 2014 to June 2015 in Fuzhou General Hospital of Nanjing Military Command, dividing into four groups: POP with or without coexisting occult stress urinary incontinence (OSUI) in preoperation, women with persistent stress urinary incontinence (SUI) in postoperation, women without SUI in postoperation. The pudendal nerve function in preoperation was measured by using Solar Urodynamic Neuro Module, including pudendal nerve terminal motor latency (PNTML), and amplitude. Results There were statistical significance on bilateral PNTML between POP coexisting OSUI group and only severe POP group [(2.62±0.23) versus (2.40±0.26) ms in right of PNTML, (2.55 ± 0.21) versus (2.37 ± 0.30) ms in left of PNTML; all P0.05). Compared de novo SUI group with POP group in postoperation, de novo SUI group′s right of PNTML was significantly increased [(2.74 ± 0.16) versus (2.47 ± 0.26) ms; P<0.05]; and the right of PNTML was extending 2.5 standard deviation at least compared with the health′s [(2.10±0.20) ms]. Conclusions The PNTML of pudendal nerve of POP coexisting OSUI is severe than only severe POP, the velocity of nerve conduction is slowing, and PNTML extension has a predictive value for postoperative urinary incontinence. When the right of PNTML of preoperative POP increased by at least 2.5 standard deviations than health′s, the risk of SUI postoperative strongly increased, and a anti-incontinence surgery at the same time following pelvic prolapse surgery should be adviced.

Pudendal Nerve Entrapment Syndrome due to a Ganglion Cyst: A Case Report

Pudendal nerve entrapment syndrome is an unusual cause of chronic pelvic pain. We experienced a case of pudendal neuralgia associated with a ganglion cyst. A 60-year-old male patient with a tingling sensation and burning pain in the right buttock and perineal area visited our outpatient rehabilitation center. Pelvis magnetic resonance imaging showed the presence of multiple ganglion cysts around the right ischial spine and sacrospinous ligament, and the pudendal nerve and vessel bundle were located between the ischial spine and ganglion cyst at the entrance of Alcock's canal. We aspirated the lesions under ultrasound guidance, and consequently his symptoms subsided during a 6-month follow-up. This is the first report of pudendal neuralgia caused by compression from a ganglion cyst around the sacrospinous ligament.

Effect of pudendal nerve block anesthesia combined with noninvasive delivery on maternal vaginal delivery quality / 中国生化药物杂志

Objective To analysis pudendal nerve block anesthesia combined with noninvasive delivery on maternal vaginal delivery quality.Methods 60 primipara who were received vaginal delivery in our hospital were collected.All primipara were randomly divided into anesthesia group and no anesthesia group by the order of entry, 30 cases in each group.The no anesthesia group was given noninvasive delivery operation, and the anesthesia group received unilateral or bilateral nerve block anesthesia.Perineal laceration degree and incidence rate, time of the second stage of labor, neonatal asphyxia and two groups of maternal postpartum recovery were compared after the treatment.Results After the birth of a child, Compared with no anesthesia group, the incidence of maternal perineal laceration was lower in the anesthesia group, and the difference was statistically significant(P<0.05);the second stage of labor time of primipara was shorter in the anesthesia group(P<0.05); the pain score,getting out of bed activity time,average length of hospital stay,and incidence of postpartum complications of primipara were lower in the anesthesia group(P<0.05).Conclusions Pudendal nerve block anesthesia combined with noninvasive delivery operation can improve vaginal delivery quality, and have a guiding significance to clinical.

Bloqueo de nervios pudendos guiados por radioscopía. Presentación de caso clínico / Blocking of pudendal nerves guided by fluoroscopy. Presentation of clinical case

La neuralgia del nervio pudendo es un cuadro doloroso neuropático poco frecuente enmarcado dentro de los sindromes de Dolor Pélvico Crónico, caracterizado por dolor perineal que aumenta con la posición sentada. Esta entidad es de difícil tratamiento, no habiendo consenso sobre el abordaje más eficaz para aliviar el dolor. Los bloqueos de los nervios pudendos juegan un rol en el diagnóstico de la enfermedad así como en el abordaje intervencionista cuando es refractaria al tratamiento conservador. Se describe un caso clínico de un paciente de sexo masculino, con diagnóstico clínico de neuralgia del pudendo bilateral, refractaria al tratamiento farmacológico, en el cuál se practicaron bloqueos de los nervios pudendos con criterio diagnóstico y terapéutico. Se utilizó para ello una técnica guiada con radioscopia, en posición decúbito ventral, por vía transglútea. Se utilizó bupivacaína al 0.5% sin esteroides asociados. Estos bloqueos obtuvieron un alivio del dolor mayor a un 50% por 4 a 6 semanas debiendo ser repetidos en 3 oportunidades. En un intento de lograr alivio de mayor duración se realizó una radiofrecuencia pulsada de los pudendos, sin respuesta analgésica efectiva. Se concluye que los bloqueos de los nervios pudendos con anestésicos locales pueden ser útiles en el tratamiento integral de la neuralgia del pudendo. La radiofrecuencia pulsada del nervio debe ser más estudiada.

Block of pudendal nerves guided by radioscopy. Clinical case presentation. The pudendal nerve neuralgia is a rare neuropathic painful picture framed within Chronic Pelvic Pain syndromes characterized by perineal pain that increases with the sitting position. This condition is difficult to treat, there being no consensus on the most effective approach to relieve pain. Blockages of the pudendal nerves play a role in disease diagnosis as well as the interventional approach when it is refractory to conservative treatment. It is described a case of a male patient with clinical diagnosis of bilateral pudendal neuralgia refractory to drug therapy, in which the pudendal nerve blocks were performed with diagnostic and therapeutic criteria. We used to do a technique guided fluoroscopy/radioscopy in ventral decubitus position, via transglútea. We used 0.5% bupivacaine without associated steroids. These blocks obtained greater pain relief at 50% for 4 to 6 weeks must be repeated on 3 occasions. In an attempt to achieve longer-lasting relief from a pulsed radiofrequency pudendal performed without effective analgesic response. We conclude that the pudendal nerve blocks with local anesthetics may be useful in the comprehensive treatment of pudendal neuralgia. The pulsed radiofrequency nerve should be studied further.

Ultrasound-guided pudendal nerve pulsed radiofrequency in patients with refractory pudendal neuralgia: Three cases report

Pudendal neuralgia is characterized by severe sharp pain along the innervation area of pudendal nerve, which may be worsened when sitting position. Successful pudendal nerve block is crucial to the diagnosis of pudendal neuralgia. Although fluoroscopy-guided pudendal nerve blocks have traditionally been performed, recently ultrasound-guided pudendal nerve blocks were reported. For the long term effect of nerve block, pulsed radiofrequency was performed under fluoroscopic guidance in some reports. We report our successful experiences of three cases using ultrasound-guided pulsed radiofrequency.

Síndrome de atrapamiento del nervio pudendo / Pudendal nerve entrapment syndrome

Introducción: el síndrome de atrapamiento del nervio pudendo se caracteriza por dolor vulvar, perineal, trastornos de la incontinencia fecal y urinaria, disfunción sexual y frecuentemente dolor quemante en el talón; se encuentra también dolor clitoridio. Objetivos: presentar dos casos del síndrome de atrapamiento del nervio pudendo y su tratamiento conservador (infiltrativo). Métodos: se describen dos casos con síndrome de atrapamiento del nervio pudendo, la primera de 36 años y 7 años con dolor y la segunda con 38 años y 8 años con dolor en el hospital "Abel Santamaría Cuadrado", durante los años 2007 y 2008. Resultados: se realizó tratamiento infiltrativo con esteroides en la zona del dolor cada 4-6 sem con cuatro o 6 dosis. Conclusiones: las pacientes tuvieron mejoría clínica del dolor con el tratamiento infiltrativo.

Introduction: this syndrome is characterized by vulvar, perineal pain, fecal and urinary incontinence, sexual dysfunction, burning pain in the heel and costal ridge; clitoridean pain is also found. Objectives: to present two cases suffering from Pudendal Nerve Entrapment Syndrome, applying a conservative treatment (infiltration block). Methods: two cases suffering from Pudendal Nerve Entrapment Syndrome are described in this paper. The first one was 36 years old women with and 7 year-pain and the second one was 38 years old woman with 8 year-pain. Both were treated at Abel Santamaría Cuadrado Teaching General Hospital from 2007 to 2008. Results: infiltration block with steroids in the pain region every 4-6 week per four or 6 doses was performed. Conclusion: the patients showed significant clinical improvement of the pain and symptoms disappeared.

Excitación sexual permanente y síndrome doloroso pelviano por lesión del nervio pudendo poshisterectomía / Permanent sexual arousal and pelvic pain syndrome by pudendal nerve injury after histerectomy

Introducción: el síndrome de atrapamiento del nervio pudendo fue descrito por Gérard Amarenco en 1987. Obedece a múltiples causas y tiene como denominador común la presencia de dolor neurítico genital, perineal y anal, acompañado de forma variable por síntomas de la esfera sexual, urinaria o defecatoria. Es poco conocido en el ámbito clínico y se confunde frecuentemente con otras entidades. Objetivo: sensibilizar a los profesionales de la salud en el diagnóstico y tratamiento del síndrome de atrapamiento del nervio pudendo y su impacto en la calidad de la vida y la sexualidad. Métodos: se aplicó el método clínico mediante la realización de una anamnesis detallada y un examen físico exhaustivo, con énfasis en el suelo pélvico, además de la realización de exámenes complementarios. Se realizó una búsqueda bibliográfica especializada. Resultados: la anamnesis y el examen físico conllevaron al diagnóstico presuntivo de lesión del nervio pudendo. Se evidenció la presencia de lesión bilateral del nervio pudendo mediante estudios electrofisiológicos. Conclusiones: el caso que se presenta muestra lesión bilateral del nervio pudendo secundaria a la realización de una histerectomía. Se documenta la aparición de dolor neuropático que genera un aparente aumento del deseo sexual con un incremento de la actividad sexual en una mujer posmenopáusica. Se destaca la necesidad de prevenir las lesiones del nervio durante las cirugías pelvianas y su impacto en la sexualidad.

Introduction: the Pudendal Nerve Entrapment Syndrome was described for the first time by Gérard Amarenco in 1987. It is caused by several etiologies and is characterized by neuritic pain located in the genital, perineal, and anal areas. Sexual, urinary and fecal dysfunctions could accompany the pain. It is often misdiagnosed in the clinical setting. Objective: to sensitize the health care provider on the diagnosis and treatment of the Pudendal Nerve Entrapment Syndrome and its impact on sexual health. Methods: the clinical method was applied by performing a detailed history and a thorough physical examination, with emphasis on the pelvic floor, in addition to further examination. A specialized literature review was conducted. Results: the history and physical examination entailed the presumptive diagnosis of pudendal nerve injury. This study revealed the presence of bilateral pudendal nerve injury by electrophysiological studies. Conclusiones: this case shows bilateral pudendal nerve injury, after performing a hysterectomy. The development of neuropathic pain generating an apparent increase in sexual desire with increased sexual activity in a postmenopausal woman is documented. The need to prevent nerve injury during pelvic surgery and its impact on sexuality is highlighted.

The effect of different frequencies of pudendal nerve electrical stimulation on female stress urinary incontinence / 国际中医中药杂志

Objective To investigate the effect of different frequencies of pudendal electrical nerve stimulation on female stress urinary incontinence.Methods 60 SUI female patients from Shanghai Research Institute of Acupuncture and Meridian affiliated Yue Yang Hospital were enrolled in a three-times-per-week treatment group (30 paients) and a twice-per-week treatment group (30 patients).Both groups were treated by pudendal nerve electrical stimulation for twelve times.The change of therapeutic effect,symptoms index were observed in both groups before and after the treatment.Results ① Comparison of clinical efficacy:The therapeutic rate of three-times-per-week treatment group was 63.3％ (19/30),the total effective rate was 90.0％ (27/30); the therapeutic rate of twice-per-week treatment group was 36.7％ (11/30),the total effective rate was 76.7％ (23/30).The therapeutic rate showed significant differences between the two groups (x2=4.267,P＜ 0.05); The total effective rate showed no differences between the two groups (x2 =l.920,P＞0.05).② Comparison of clinical symptom score and life quality score:the post-treatment clinical symptom scores of the both groups improved significantly compared with the pre-treatment (tthee-times-prt-week=7.972,ttwice-per-week=9.520,both P＜0.01).Clinical symptom score of three-times-per-week treatment group improved better than twice-per-week treatment group (P＜0.01).Conclusion Three-times-per-week of pudendal nerve electrical stimulation has a better effect on treating female SUI patients.