Puesta al día en el diagnóstico y tratamiento de la vulvodinia / Update on the Diagnosis and Treatment of Vulvodynia

Contexto: La vulvodinia es una entidad clínica compleja y multifactorial. Se define como un malestar vulvar crónico caracterizado por quemazón, escozor o irritación. Es sabida su dificultad diagnóstica y su manejo. Objetivos: Revisar la literatura médica de los últimos 10 años desde un punto de vista crítico. Adquisición de evidencia: Se realizó una búsqueda en Medline/Pubmed y librería Cochrane usando los términos vulvodynia y vestibulodynia, a los que se añadieron etiology, epidemiology, diagnosis, neurophysiological test and treatment or management. Síntesis de evidencia: A pesar de los avances conseguidos en todos los aspectos de la vulvodinia, hoy la metodología utilizada en buen número de casos no tiene la solidez estadística deseable: pocos grupos controles o placebo y estudios a doble ciego, falta de uniformidad en las escalas, índices y cuestionarios para la correcta evaluación del dolor antes y después del tratamiento y una utilización de criterios diagnósticos discutible. Se ha visto en los estudios analizados la poca utilización de medios diagnósticos neurofisiológicos que validen los hallazgos clínicos. Los tratamientos médicos se muestran en la mayoría de los trabajos examinados poco efectivos. La fisioterapia y la terapia cognitiva-conductual parecen ser herramientas terapéuticas prometedoras. La cirugía (vestibulectomía) destaca por la eficacia demostrada en las publicaciones estudiadas. Conclusiones: El abordaje multidisciplinar es siempre necesario. El tratamiento médico tópico, el psicológico y la fisioterapia pueden tener efectos sumatorios y convertirse en una alternativa a la cirugía. Se precisan nuevas vías de investigación y estudios más reglados (AU)

Context: Vulvodynia is a complex and multifactorial clinical condition. It is defined as chronic vulvar discomfort characterized by burning, stinging or irritation. Its diagnostic difficulty and treatment is known. Objectives: To review the medical literature of the last 10 years from a critical point of view. Evidence Acquisition: A search was made in Medline/Pubmed and the Cochrane Library using the terms vulvodynia and vestibulodynia to which etiology, epidemiology, diagnosis, neurophysiological test and treatment or management, were added. Evidence Synthesis: In spite of the advances achieved in all of the aspects of vulvodynia, the methodology used at present in many cases does not have the desirable statistical soundness: there are few control or placebo-controlled groups and double-blind studies. Uniformity is lacking in the scales, indexes and questionnaires for the correct evaluation of pain before and after the treatment and debatable diagnostic criteria are use. The limited use of neurophysiological diagnostic resources that validate the clinical findings has been observed in the studies analyzed. In most of the works, the medical treatments have been shown to be ineffective. Physiotherapy and cognitive-behavioral therapy seem to be promising therapeutic tools. Surgery (vestibulectomy) stands out by its demonstrated efficacy in the publications studied. Conclusions: A multidisciplinary approach is always necessary. Topical medical, psychological and physical therapy treatments may have sum effects and become an alternative to surgery. New pathways of research and more regulated studies are required (AU)

[Update on the diagnosis and treatment of vulvodynia]. / Puesta al día en el diagnóstico y tratamiento de la vulvodinia.

CONTEXT: Vulvodynia is a complex and multifactorial clinical condition. It is defined as chronic vulvar discomfort characterized by burning, stinging or irritation. Its diagnostic difficulty and treatment is known. OBJECTIVES: To review the medical literature of the last 10 years from a critical point of view. EVIDENCE ACQUISITION: A search was made in Medline/Pubmed and the Cochrane Library using the terms vulvodynia and vestibulodynia to which etiology, epidemiology, diagnosis, neurophysiological test and treatment or management, were added. EVIDENCE SYNTHESIS: In spite of the advances achieved in all of the aspects of vulvodynia, the methodology used at present in many cases does not have the desirable statistical soundness: there are few control or placebo-controlled groups and double-blind studies. Uniformity is lacking in the scales, indexes and questionnaires for the correct evaluation of pain before and after the treatment and debatable diagnostic criteria are use. The limited use of neurophysiological diagnostic resources that validate the clinical findings has been observed in the studies analyzed. In most of the works, the medical treatments have been shown to be ineffective. Physiotherapy and cognitive-behavioral therapy seem to be promising therapeutic tools. Surgery (vestibulectomy) stands out by its demonstrated efficacy in the publications studied. CONCLUSIONS: A multidisciplinary approach is always necessary. Topical medical, psychological and physical therapy treatments may have sum effects and become an alternative to surgery. New pathways of research and more regulated studies are required.

[Update in pudendal nerve entrapment syndrome: an approach anatomic-surgical, diagnostic and therapeutic]. / Actualización del síndrome de atrapamiento del nervio pudendo: enfoque anatómico-quirúrgico, diagnóstico y terapéutico.

INTRODUCTION: The syndrome of pudendal nerve entrapment (SANP) is widely unknown and often misdiagnosed or confused with other diseases. It was first described by Amarenco in 1987. The classic clinical manifestation is pudendal neuralgia, a neuropathic pain in the genital area. OBJECTIVES: To make known its existence to the urology professionals through a systematic review of existing literature and its potential for diagnosis and treatment. MATERIAL AND METHODS: We performed a literature search through the database Pubmed using the terms Pudendal nerve, Pudendal nerve entrapment syndrome, Pelvic floor neuropathic pain, Pelvic floor myofascial syndrome, Pudendal nerve decompression. Also, selected works in English, Spanish and French, also reviewing the articles relate this work. RESULTS: We develop the highlights of the syndrome: anatomy, etiology, pathophysiology, clinical diagnosis, ecodoppler of internal pudendal artery, electrophysiological studies, diagnostic criteria, medical therapy, physical therapy treatments and surgery. CONCLUSION: It is an uncommon cause of pain in the pelvic floor and greatly affects quality of life of patients. Today, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results.

Actualización del síndrome de atrapamiento del nervio pudendo: enfoque anatómico-quirúrgico, diagnóstico y terapéutico / Update in pudendal nerve entrapment syndrome: an approach anatomic-surgical, diagnostic and therapeutic

Introducción: El síndrome de atrapamiento del nervio pudendo (SANP) es un gran desconocido y suele ser mal diagnosticado o confundido con otras patologías. Fue descrito por primera vez por Amarenco en 1987. La manifestación clínica clásica es la neuralgia del pudendo, un dolor neuropático del área genital. Objetivos: Dar a conocer su existencia a los profesionales de la urología a través de una revisión sistemática de la bibliografía existente y sus posibilidades de diagnostico y tratamiento. Material y método: Realizamos una búsqueda bibliográfica a través de la base de datos «Pubmed» utilizando los términos «Pudendal nerve», «Pudendal nerve entrapment síndrome», «Pelvic floor neuropathic pain», «Pelvic floor myofascial síndrome», «Pudendal nerve decompression». Asimismo, seleccionamos los trabajos en lengua inglesa, española y francesa, revisando también los artículos que dichos trabajos refieren. Resultados: Se desarrollan los aspectos más destacados del síndrome: anatomía, etiología, fisiopatología, diagnostico clínico, ecodoppler de la arteria pudenda interna, estudios electrofisiológicos, criterios diagnósticos, terapéutica médica, tratamiento con fisioterapia y tratamiento quirúrgico. Conclusión: Es una causa poco frecuente de dolor en el suelo pélvico y afecta en gran medida la calidad de vida de los pacientes. Hoy, disponemos de herramientas diagnósticas y terapéuticas que nos permiten tratar este síndrome invalidante con buenos resultados (AU)

Introduction: The syndrome of pudendal nerve entrapment (SANP) is widely unknown and often misdiagnosed or confused with other diseases. It was first described by Amarenco in 1987. The classic clinical manifestation is pudendal neuralgia, a neuropathic pain in the genital area. Objectives: To make known its existence to the urology professionals through a systematic review of existing literature and its potential for diagnosis and treatment. Materials and methods: We performed a literature search through the database “Pubmed” using the terms “Pudendal nerve”, “Pudendal nerve entrapment syndrome,” “Pelvic floor neuropathic pain”, “Pelvic floor myofascial syndrome,” “Pudendal nerve decompression”. Also, selected works in English, Spanish and French, also reviewing the articles relate this work. Results: We develop the highlights of the syndrome: anatomy, etiology, pathophysiology, clinical diagnosis, ecodoppler of internal pudendal artery, electrophysiological studies, diagnostic criteria, medical therapy, physical therapy treatments and surgery. Conclusion: It is an uncommon cause of pain in the pelvic floor and greatly affects quality of life of patients. Today, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results (AU)

[Myofascial pain syndrome in the pelvic floor: a common urological condition]. / Síndrome de dolor miofascial del suelo pélvico: una patología urológica muy frecuente.

INTRODUCTION: Myofascial pain syndrome in the pelvic floor is a very common condition in the urological field and is often ignored or misdiagnosed. OBJECTIVES: To present the prevalence of this syndrome to professionals of urology through a systematic review of existing literature and its potentials for diagnosis and treatment. MATERIALS AND METHODS: We performed a literature search through the database "Pubmed" using the terms "Trigger points", "myofascial pain", "referred pain", "infiltrations" and "physical therapy", to which we add the term "pelvic floor". Then, we select the works in English, Spanish and French that we might like. RESULTS: We develop the highlights of the syndrome: anatomy, etiology, anatomical-clinical correlation, epidemiology, perpetuating factors, diagnosis, medical therapy and physiotherapy treatment. CONCLUSION: It is the most common cause of pain in the pelvic floor and greatly affects quality of life of patients. Nowadays, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results.

Síndrome de dolor miofascial del suelo pélvico: una patología urológica muy frecuente / Myofascial pain syndrome in the pelvic floor: A common urological condition

Introducción: El síndrome de dolor miofascial de suelo pélvico es una entidad nosológica muy frecuente en el campo urológico y suele ser ignorada o mal diagnosticada. Objetivos: Dar a conocer la prevalencia de este síndrome a los profesionales de la urología a través de una revisión sistemática de la bibliografía existente y sus posibilidades de diagnóstico y tratamiento. Materiales y métodos: Realizamos una búsqueda bibliográfica a través de la base de datos «Pubmed» utilizando los términos «trigger points», «myofascial pain», «referred pain», «infiltrations» y «physical therapy», a los que añadimos el término «pelvic floor». Entonces, seleccionamos los trabajos en lengua inglesa, española y francesa que nos podrían interesar. Resultados: Se desarrollan los aspectos más destacados del síndrome: anatomía, etiología, correlación anatomoclínica, epidemiología, factores de perpetuación, diagnóstico, terapéutica médica y tratamiento con fisioterapia. Conclusión: Es la causa más frecuente de dolor en el suelo pélvico y afecta, en gran medida, la calidad de vida de los pacientes. Hoy, disponemos de herramientas diagnósticas y terapéuticas que nos permiten tratar este síndrome invalidante con buenos resultados (AU)

Introduction: Myofascial pain syndrome in the pelvic floor is a very common condition in the urological field and is often ignored or misdiagnosed. Objectives: To present the prevalence of this syndrome to professionals of urology through a systematic review of existing literature and its potentials for diagnosis and treatment. Materials and methods: We performed a literature search through the database "Pubmed" using the terms "Trigger points", "myofascial pain", "referred pain", "infiltrations" and "physical therapy", to which we add the term "pelvic floor". Then, we select the works in English, Spanish and French that we might like. Results: We develop the highlights of the syndrome: anatomy, etiology, anatomical-clinical correlation, epidemiology, perpetuating factors, diagnosis, medical therapy and physiotherapy treatment. Conclusion: It is the most common cause of pain in the pelvic floor and greatly affects quality of life of patients. Nowadays, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results (AU)