Selection criteria for surgical treatment of PN

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Selection criteria for surgical treatment of PN

Postby nyt » Sat Apr 16, 2016 2:05 pm

This is only the abstract and a small study. However, anyone who is considering surgery or their surgery totally failed the used of guided pudendal blocks appears to be of value to determine if you will have decrease in pain after your surgery.

Selection criteria for surgical treatment of pudendal neuralgia.

Neurourol Urodyn. 2016 Mar 21. doi: 10.1002/nau.22988. [Epub ahead of print]

Charlotte W, Sebastian D, Viviane T, Luc B
Department of Digestive Surgery, CHU Brugmann, Bruxelles, Belgium.


Pudendal neuralgia is the clinical expression of a chronic compression of the pudendal nerve. The diagnosis is based on a set of five criteria, called Nantes criteria. Four of the criteria are clinical and the last requires evaluation of the anesthetic response to CT-guided infiltration of the pudendal nerve. The aim of our study is to evaluate the relevance of anesthetic test response to select patients for surgery, and whether this criterion can be used to predict its success.

Retrospective analysis of a cohort of 34 patients undergoing surgical treatment. In our cohort, we included six patients with negative CT-guided pudendal nerve infiltration test.

Of the 28 patients that met all five Nantes criteria, 64% (18 patients) responded well to surgery. In contrast, 100% of the six patients with a negative anesthetic test failed to show an amelioration of symptoms after surgical treatment (P = 0.006). In our analysis, there was no significant difference in surgery response when men were compared to women (P = 0.387), when procedure was unilateral or bilateral (P = 0.562), or when duration of symptoms was long (P = 0.412). We observed a difference in terms of age between the group of responders and non-responders, although this difference did not reach the threshold of significance (P = 0.216).

The selection of candidates for surgery should always include a single diagnostic anesthetic injection of the pudendal nerve, as the fifth of the Nantes criteria is an effective predictor of the success of surgery. Neurourol.
2/07 LAVH and TOT 7/07 TOT right side removed 9/07 IL, IH and GN neuropathy 11/07 PN - Dr. Howard
6/08 Obturator neuralgia - Dr. Conway 11/08 Disability, piriformis syndrome - Dr. Howard
4/09 Bilateral obturator decompression surgery, BLL RSD - Dr. Howard
9/10 Removed left side TOT, botox, re-evaluate obturator nerve - Dr. Hibner
2/11 LFCN and saphenous neuralgia - Dr. Dellon 2/11 MRI with Dr. Potter - confirmed entrapment
5/11 Right side TG - Dr. Hibner 2012 Left side TG - Dr. Hibner
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