Pudendal Neuromodulation is Feasible and Effective After Pudendal Nerve Entrapment Surgery |
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| Affiliation: | 1. Beaumont Health, Department of Urology, Royal Oak, MI, USA;2. Oakland University William Beaumont School of Medicine, Rochester, MI, USA;1. Menopause Andropause Research Center, Midwifery Department, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran;2. Department of Midwifery, School of Nursing and Midwifery, Menopause Andropause Research Center, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran;3. Department of Pharmaceutics, School of Pharmacy, Nanotechnology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran;4. Department of Biostatistics and Epidemiology, School of Health, Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran;1. University Medical Centre Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology, Hamburg, Germany;2. University Medical Centre Hamburg-Eppendorf, Institute of Sex Research, Sexual Medicine, and Forensic Psychiatry, Hamburg, Germany;3. Federal Centre for Health Education, Evaluation, Methods, Research Data, Cologne, Germany;1. Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA;2. Department of Plastic Surgery, University of Virginia, Charlottesville, VA, USA;3. Department of Urology, Temple University Hospital, Philadelphia, PA, USA;4. Center for Urban Bioethics, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA;5. Department of Plastic and Reconstructive Surgery, Temple University Hospital, Philadelphia, PA, USA;1. School of Public Health, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China;2. Health Guidance Department, Shanghai Municipal Center for Health Promotion, Shanghai, China;1. Neuro-Uro-Andrology Department, Raymond Poincare University Hospital, Garches, France;2. Faculty of Medicine, Versailles Saint Quentin University, Montigny le Bretonneux, Paris Saclay, France;3. Pelvipharm SAS, Montigny le Bretonneux, France;1. Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA;2. Department of Urology, Dalhousie University, Halifax, Canada;3. Department of Microbiology & Immunology, Miller School of Medicine, University of Miami, Miami, FL, USA |
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| Abstract: | BackgroundPatients 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.AimWe examined pudendal neuromodulation outcomes in patients with prior PNES.MethodsPatients 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.OutcomesPatients with pudendal neuromodulation and prior PNES were compared to patients with no prior PNES who had pudendal lead placement.ResultsFifteen 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.Clinical ImplicationsPudendal 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.Strengths & LimitationsStudy 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 PNConclusionChronic 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. |
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