阴部神经分布的顽固性疼痛患者可能受益于阴部神经调节;然而,有些人可能以前接受过阴部神经卡压手术(PNES),可能改变神经解剖结构和功能。
我们检查了既往PNES患者的阴部神经调节结果。
有PNES和四极病史的患者,对泌尿生殖器疼痛的阴部铅放置进行了综述。从现有的医疗记录中收集症状和结果。
将有阴部神经调节和先前PNES的患者与没有先前PNES且有阴部导线放置的患者进行比较。
评估了15例既往有1、2或3个PNES病史的患者(分别为n=13、1和1)。大多数(10;67%)是女性,双侧疼痛(9;60%),和5-26年的症状。在试验了线索之后,膀胱症状和疼痛在12人中有8人和14人中有9人得到改善,分别,80%(12/15)的患者接受了永久性发生器植入。当之前的PNES患者与之前没有PNES的患者(n=43)进行比较时,性别(67%vs77%女性;P=.50)和年龄(中位数63vs58岁;P=.80),是相似的;然而,BMI不同(平均24vs29;P=.008),发生器植入比例较低(12/15;80%vs42/43;98%;P=.049)。重要的是,两组间的中位导线植入时间(48分钟vs50分钟;P=.65)无差异.
阴部神经调节有可能为非常难以治疗的人群提供疼痛缓解;此外,以前的PNES手术似乎不会使引线放置明显更具挑战性.
研究优势包括成为泌尿生殖器疼痛的三级转诊中心,并由一名外科医生以有计划的方式执行所有手术。局限性包括回顾性研究设计,小样本量和不同的PN方法结论:即使在以前的PNES后,慢性阴部神经调节也可以是一个可行的选择。KristenM.Meier,PatrickM.Vecellio,KimA.Killinger,JudithA.Boura,KennethM.Peters.阴部神经调节在阴部神经压迫手术后是可行和有效的。JSexMed2022;19:995-1001。
Patients with intractable pain in the pudendal nerve distribution may benefit from pudendal neuromodulation; however, some may have previously undergone pudendal nerve entrapment surgery (PNES), potentially altering nerve anatomy and function.
We examined pudendal neuromodulation outcomes in patients with prior PNES.
Patients with a history of PNES and quadripolar, tined pudendal lead placement for urogenital pain were reviewed. Symptoms and outcomes were collected from existing medical records.
Patients with pudendal neuromodulation and prior PNES were compared to patients with no prior PNES who had pudendal lead placement.
Fifteen patients with a history of 1, 2, or 3 prior PNES (n = 13, 1, and 1, respectively) were evaluated. Most (10; 67%) were female, with bilateral pain (9; 60%), and symptoms of 5-26 years. After trialing the lead, bladder symptoms and pain were improved in 8 of 12 and 9 of 14 patients, respectively, and 80% of patients (12/15) underwent permanent generator implantation. When prior PNES patients were compared to those with no prior PNES (n = 43), gender (67% vs 77% female; P = .50) and age (median 63 vs 58 years; P = .80), were similar; however, BMI differed (mean 24 vs 29; P = .008) and a lower proportion (12/15; 80% vs 42/43; 98%; P = .049) had generator implantation. Importantly, median lead implant time (48 vs 50 minutes; P = .65) did not differ between the 2 groups.
Pudendal neuromodulation has the potential to provide pain relief for a very difficult-to-treat population; furthermore, it does not appear that prior PNES surgery made lead placement significantly more challenging.
Study strengths include being a tertiary referral center for urogenital pain and having a single surgeon perform all procedures in a regimented way. Limitations include the retrospective study design, small sample size and various approaches to PN CONCLUSION: Chronic pudendal neuromodulation can be a viable option even after prior PNES. Kristen M. Meier, Patrick M. Vecellio, Kim A. Killinger, Judith A. Boura, Kenneth M. Peters. Pudendal Neuromodulation is Feasible and Effective After Pudendal Nerve Entrapment Surgery. J Sex Med 2022;19:995-1001.