[Modern algorithm for treating pudendal neuralgia: 212 cases and 104 decompressions].
Clinical signs and symptoms of the pudendal neuralgia are very rich, with a great individual variability. The clinical diagnosis is difficult. It is confirmed or invalidated by the electrophysiologicals tests. Since October 1998 patient selection has been possible using a diagnosis score. Over a four-year period, the diagnosis of pudendal neuralgia was confirmed by electrophysiological investigations in 212 subjects. We rejected 12 patients because of a radiculo-medullary organic etiology. We only describe here cases of women with a peripheral pudendal nerve injury (200 patients). Thirty-eight neuropathies free of canal symptoms (obstetrical, post-traumatic...) were treated by infiltration therapy. The study of a total of 162 canal syndromes showed prevalent injury at the sacro-spino-tuberal ligamental grip which was observed in 68% of the cases, compared to the Alcock canal which was present in only 20% of the cases. One hundred four of these patients underwent surgical decompression via a trans-ischio-rectal approach after negative results of the infiltration therapy. We report here the surgical methodology, the post-op follow-up and the results, which appear quite successful: after one year 86% of the subjects are symptom-free or with a significant reduction of pain.
Bautrant
E
E
Centre Libéral Aixois de Réhabilitation Pelvi-périnéale, Le Grand Angle, 4, place Barthélémy Niollon, 13100 Aix-en-Provence.
de Bisschop
E
E
Vaini-Elies
V
V
Massonnat
J
J
Aleman
I
I
Buntinx
J
J
de Vlieger
J
J
Di Constanzo
M
M
Habib
L
L
Patroni
G
G
Siboni
S
S
Céas
B
B
Schiby
V
V
Uglione-Céas
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000294:innervation*; D019299:Decompression, Surgical / Q000379:methods; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000150:complications; D009437:Neuralgia / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D059348:Peripheral Nerve Injuries; D016896:Treatment Outcome; D014621:Vagina / Q000294:innervation*