Pudendal nerve decompression in perineology: a case series.
BACKGROUND
Perineodynia (vulvodynia, perineal pain, proctalgia), anal and urinary incontinence are the main symptoms of the pudendal canal syndrome (PCS) or entrapment of the pudendal nerve. The first aim of this study was to evaluate the effect of bilateral pudendal nerve decompression (PND) on the symptoms of the PCS, on three clinical signs (abnormal sensibility, painful Alcock's canal, painful "skin rolling test") and on two neurophysiological tests: electromyography (EMG) and pudendal nerve terminal motor latencies (PNTML). The second aim was to study the clinical value of the aforementioned clinical signs in the diagnosis of PCS.


METHODS
In this retrospective analysis, the studied sample comprised 74 female patients who underwent a bilateral PND between 1995 and 2002. To accomplish the first aim, the patients sample was compared before and at least one year after surgery by means of descriptive statistics and hypothesis testing. The second aim was achieved by means of a statistical comparison between the patient's group before the operation and a control group of 82 women without any of the following signs: prolapse, anal incontinence, perineodynia, dyschesia and history of pelvi-perineal surgery.


RESULTS
When bilateral PND was the only procedure done to treat the symptoms, the cure rates of perineodynia, anal incontinence and urinary incontinence were 8/14, 4/5 and 3/5, respectively. The frequency of the three clinical signs was significantly reduced. There was a significant reduction of anal and perineal PNTML and a significant increase of anal richness on EMG. The Odd Ratio of the three clinical signs in the diagnosis of PCS was 16,97 (95% CI = 4,68 - 61,51).


CONCLUSIONS
This study suggests that bilateral PND can treat perineodynia, anal and urinary incontinence. The three clinical signs of PCS seem to be efficient to suspect this diagnosis. There is a need for further studies to confirm these preliminary results.
Beco
Jacques
J
Gynaecology, CHU Sart-Tilman, University of Liège, B-4000 Liège, Belgium. jacques.beco@skynet.be
Climov
Daniela
D
Bex
Michèle
M
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000294:innervation; D016022:Case-Control Studies; D019299:Decompression, Surgical / Q000379:methods*; D004576:Electromyography; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D005260:Female; D005836:Genitalia, Female / Q000294:innervation*; D006801:Humans; D008875:Middle Aged; D020422:Mononeuropathies / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D010502:Perineum; D010525:Peripheral Nerves; D012189:Retrospective Studies; D013577:Syndrome; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*