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Modern principles of surgical treatment of pudendal neuralgia (review)

Year: 2022, volume 18 Issue: №4 Pages: 557-561
Heading: neurosurgery Article type: Review
Authors: Kuzmenkova L.N., Chagava D.A., Dreval O.N., Chekhonatskiy V.A., Kuznetsov A.V., Chekhonatskiy A.A., Mykhina O.V., Sidneva L.A.
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Abstract. Objective: to analyze the literature data on the effectiveness of modern methods of surgical treatment of pudendal neuropathy to select the most optimal of them. To write the review we studied databases: PubMed, MEDLINE, Cohrane Library, eLibrary using keywords: "pudendal neuralgia", "surgical treatment", "open decompression of the pudendal nerve", "pulse radiofrequency denervation". Depth of search: from 1966 to 2022. The number of analyzed sources was 75. Thirty nine were selected for the review.. Despite the availability of a variety of surgical interventions, so far we have not been able to achieve the most positive results of treatment of this pathology. Open decompression of the genitourinary nerve, while having satisfactory treatment results, simultaneously increases the probability of postoperative complications. Sacral stimulation and pudendal nerve stimulation have fewer complications, but are characterized by ambiguous results. The use of pulsed radiofrequency denervation of the pudendal nerve leads to a significant regression of the pain syndrome in the postoperative period and, due to the least invasiveness, practically has no postoperative complications. However, the samples of patients treated by this method presented in the literature are too few for an unambiguous judgment. Therefore, the question of choosing the most effective method of surgical aid in pudendal nerve neuropathy remains open.

Keywords: chronic pelvic pain, pudendal neuralgia

Bibliography:
1. Rachin SA, Parsamiyn RR, Rachin AP, et al. Chronic pelvic pain: from correct diagnosis to adequate therapy. Nevrologia, nejropsihiatria, psihosomatika. 2020; 12 (2): 12-6.
2. Rhame ЕЕ, Levey КА, Gharibo CG. Successful treatment of refractory pudendal neuralgia with pulsed radiofrequen-cy. Pain Physician. 2009; (12): 633-8.
3. Waxweiler C, Dobos S. Selection criteria for surgical treatment of pudendal neuralgia. Neurourol Urodyn. 2017; 36 (3); 663-6.
4. Holloran-Schwartz MB. Surgical evaluation and treatment of the patient with chronic pelvic pain. Obstet Gynecol Clin North Am. 2014; 41 (3): 357-69. DOI: 10.1016/j.ogc. 2014.05.003.8 5. Aziz Q, Giambererdino MA, Barke A. The IASP classification of chronic pain for ICD-11: chronic secondary visceral pain. Pain. 2019; 160 (1): 69-76.8 6. Nicholas M, Vlaeyen JWS, Rief W. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain. 2019; 160(1): 28-37.
7. Barinov AN. Tunnel neuropathies: justification of patho-genetic therapy. The Doctor. 2012; (4): 31-7.
8. Aasvang Е, Kehlet Н. Chronic postoperative pain: The case of inguinal herniorrhaphy. Br J Anesth. 2005; (95): 69-76.
9. Al-dabbagh AK. Anatomical variations of the inguinal nerves and risks of injury in 110 hernia repairs. Surg Radiol Anat. 2002; (24): 102-7.
10. Robert R, Prat-Pradal D, Labat JJ, et al. Anatomic basis of chronic perineal pain: Role of the pudendal nerve. Surg Radiol Anat. 1998; (20): 93-8.
11. Stav K, Dwyer PL, Roberts L. Pudendal neuralgia Fact or fiction? Obstet Gynecol Sury. 2009; 64 (3): 190-9.
12. Hruby S. Anatomy of pudendal nerve at urogenital diaphragm — new critical site for nerve entrapment. Urology. 2005; 66 (5): 949-52.
13. Labat JJ, Riant T, Robert R, et al. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn. 2008; 27 (4): 306-10.
14. Zaitcev AV, Sharov MN, Ratchin AP. The quantitative sensory testing in phenotyping patients with chronic pelvic pain. Int J Urol. 2019; 26(1): 76-86.
15. Scudamore JH, Yates MJ. Pudendal block — a misnomer? Lancet. 1966; (1): 23-4.
16. Robert R, Labat JJ, Lehur PA, et al. Clinical, neurophysi-ologic and therapeutic remarks from anatomic data on the pudendal nerve in some cases of perineal pain. Chirurgie. 1989; (115): 515-20.8 17. Shafik A. Pudendal canal syndrome. Description of a new syndrome and its treatment. Report of 7 cases. Coloprocto-logy. 1991; (13): 102-10.
18. Jacques B, Climov D. Michele bex pudendal nerve decompression in perineology: a case series. ВМС Surg. 2004; 4 (1): 15. DOI: 10.1186/1471-2482-4-15.
19. Bautrant E, de Bisschop E, Vaini-Elies V, et al. Modern algorithm for treating pudendal neuralgia: 212 cases and 104 decompressions. J Gynecol Obstet Biol Reprod. 2003; (32): 705-12.
20. Robert R, Labat JJ, Bensignor M, et al. Decompression andtransposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation. Eur Urol. 2005; 47 (3): 403-8.
21. Chekhonatskiy AA, Chekhonatskiy VA. Spinal cord neurostimulation in the complex treatment of neurological symptoms of cervical spine stenosis. In: Innovative technologies in fundamental, clinical and preventive medicine: a collection of scientific papers. Saratov: Amirit, 2018: p. 138-9.
22. Everaert К, Devulder J, De Muynck M, et al. The pain cycle: implications for the diagnosis and treatment of pelvic pain syndromes. Int Urogynecol J Pelvic Floor Dysfunct. 2001; (12): 9-14.
23. Siegal S, Paszkiewicz E, Kirkpatrick C, et al. Sacral nerve stimulation in patients with chronic intractable pelvic pain. J Urol. 2001; (166): 174-5.
24. Marcelissen T, Jacobs R, van Kerrebroeck P, et al. Sacral neuromodulation as a treatment for chronic pelvic pain. J Urol. 2011; (186): 38-93.
25. Peters KM, Killinger KA, Boguslawski BM, et al. Chronic pudendal neuromodulation: expanding available treatment options for refractory urologic symptoms. Neurourol Urodyn. 2010; (29): 126-71.
26. Peters KM, Feber KM, Bennett RC. Sacral versus pudendal nerve stimulation for voiding dysfunction: a prospective, single-blinded, randomized, crossover trial. Neurourol Urodyn. 2005; (24): 64-7.
27. Roberts LH, Vollstedt A, Volin J, et al. Initial experience using a novel nerve stimulator for the management of pudendal neuralgia. Neurourol Urodyn. 2021; 40 (6): 167-7. DOI: 10.1002/nau.24735.
28. Jottard K, Bruyninx L, Bonnet P, et al. Pilot study: pudendal neuromodulation combined with pudendal nerve release in case of chronic perineal pain syndrome. The ENTRAMI technique: early results. Int Urogynecol J. 2021; 32 (10): 276-70. DOI: 10.1007/S00192-020-04565-1.
29. Racz GB, Ruiz-Lopez R. Radiofrequency procedures. Pain Practice. 2006; (6): 46-50.
30. Wu H, Groner J. Pulsed radiofrequency treatment of articular branches of the obturator and femoral nerves for the management of hip joint pain. Pain Practice. 2007; (7): 341-4.
31. Cahana A, van Zundert J, Macrea L, et al. Pulsed radiofrequency: Current clinical and biological literature available. Pain Medicine. 2006; (7): 411-23.
32. Makharita MY, Amr YM. Pulsed radiofrequency for chronic inguinal neuralgia. Pain Physician. 2015; (18): 147-55.
33. Martin DC, Willis ML, Mullinax LA, et al. Pulsed radiofrequency application in the treatment of chronic pain. Pain Practice. 2007; (7): 21-5.
34. Hamann W, Abou-Sherif S, Thompson S, Hall S. Pulsed radiofrequency applied to dorsal root ganglia causes a selective increase in ATF3 in small neurons. Pain. 2006; (10): 171-6.
35. Masala S, Calabria E, Cuzzolino A, et al. CT-guided percutaneous pulse-dose radiofrequency for pudendal neuralgia. Cardiovasc Intervent Radiol. 2014; (37): 476-81.
36. Hong MJ, Kim YD, Park JK, Hong HJ. Management of pudendal neuralgia using ultrasound-guided pulsed radiofrequency: A report of two cases and discussion of pudendal nerve block techniques. J Anesth. 2016; (30): 356-9.
37. Ozkan D, Akkaya T, Yildiz S, Comert A. Ultrasound-guided pulsed radiofrequency treatment of the pudendal nerve in chronic pelvic pain. Anaesthesist. 2016; (65): 134-6.
38. Petrov-Kondratov V, Chhabra A, Jones S. Pulsed radio-frequency ablation of pudendal nerve for treatment of a case of refractory pelvic pain. Pain Physician. 2017; (20): 451-4.
39. Chagava DA, Dreval ON, Kim VI. Our experience of using pulse radiofrequency ablation in the treatment of pudendal nerve neuralgia. Rossiiskii neirokhirurgicheskii zhurnal imeni professora A. L. Polenova. 2020; 12 (1): 44-7.

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All articles of the authors: Chagava D.A., Chekhonatsky A.A., Chekhonatsky V.A. , Dreval O.N., Kuzmenkova L.N., Kuznetsov A.V., Mykhina O.V., Sidneva L.A.

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