Abstract - Outcome from Resection of the Perineal Branches

[nyt]

Injury to Perineal Branch of Pudendal Nerve in Women: Outcome from Resection of the Perineal Branches.
Wan EL1, Goldstein AT2, Tolson H2, Dellon AL1.

J Reconstr Microsurg. 2017 Mar 4. doi: 10.1055/s-0037-1599130. [Epub ahead of print]

Abstract

Background This study describes outcomes from a new surgical approach to treat "anterior" pudendal nerve symptoms in women by resecting the perineal branches of the pudendal nerve (PBPN). Methods Sixteen consecutive female patients with pain in the labia, vestibule, and perineum, who had positive diagnostic pudendal nerve blocks from 2012 through 2015, are included. The PBPN were resected and implanted into the obturator internus muscle through a paralabial incision. The mean age at surgery was 49.5 years (standard deviation [SD] = 11.6 years) and the mean body mass index was 25.7 (SD = 5.8). Out of the 16 patients, mechanisms of injury were episiotomy in 5 (31%), athletic injury in 4 (25%), vulvar vestibulectomy in 5 (31%), and falls in 2 (13%). Of these 16 patients, 4 (25%) experienced urethral symptoms. Outcome measures included Female Sexual Function Index (FSFI), Vulvar Pain Functional Questionnaire (VQ), and Numeric Pain Rating Scale (NPRS). Results Fourteen patients reported their condition pre- and postoperatively. Mean postoperative follow-up was 15 months. The overall FSFI, and arousal, lubrication, orgasm, satisfaction, and pain domains significantly improved (p < 0.05). The VQ also significantly improved (p < 0.001) in 13 (93%) of 14 patients. The NPRS score decreased on average from 8 to 3 (p < 0.0001). All four patients with urethral symptoms were relieved of these symptoms. Conclusion Resection of the PBPN with implantation of the nerve into the obturator internus muscle significantly reduced pain and improved sexual function in women who sustained injury to the PBPN.

[stephanies]

Thank you for sharing, nyt.

[Violet M]

OK, I've heard of a clitoral neurectomy but never a resection of the perineal branch of the nerve. I wonder if they are doing the nerve on both sides and if any of these women ended up incontinent. I see that Dr. Goldstein and Dr. Dellon are in on this study. I would love to know more of the details on how they do this surgery and what complications might occur. Is the person left with a numb perineum????

Violet

[Okiegirl]

This was the approach used on me. I’m not well versed on this but Is this why I’m not responding well?

[Violet M]

Well, the outcomes 15 month post-op in the article sound very promising. Hopefully with time you will experience healing.

I was reading back through your original posts and noticed that you had some pain relief from ganglion impar blocks but that SCS did not help. I remember one gal who had good results from ganglion impar blocks and she went ahead with a phenol ganglion impar block. Since phenol is neuro-destructive it was considered to be a long-term treatment. I know initially it was very successful for her. I did not hear the long-term results.

I am also hearing good things about DRG neurostimulation which may be different from the SCS you already tried.

Just mentioning these as a treatment possibility to keep in the back of your mind in case surgery results aren't what you had hoped for. It's still very early days post-op for you though. Did your surgeon say whether he found a lot of scar tissue around the nerve -- or what might have been causing your original pain? Did he find an entrapment?

Violet