Repeat Operation for Treatment of Persistent Pudendal Nerve Entrapment After Pudendal Neurolysis

Hibner, M.; Castellanos, Mario E.; Drachman, David A.; Balducci, James

doi:10.1016/j.jmig.2011.12.022

Cited by 37 publications

(19 citation statements)

References 11 publications

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“…PRP has also been applied to reduce neuropathic pain in case where neuropathic pain is caused by arthroplasty and transgluteal decompression of the pudendal nerve [195] and to the surgical site following tonsillectomy [196]. However, despite the claims, a rigorous block-randomized, double-blind clinical study found that PRP injections were no more effective in reducing pain or improving activity than placebo saline shots for the patients [190].…”

Section: Factors From Platelet-rich Plasmamentioning

confidence: 99%

Platelet-Rich Plasma Promotes Axon Regeneration, Wound Healing, and Pain Reduction: Fact or Fiction

Kuffler

2015

Mol Neurobiol

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Platelet-rich plasma (PRP) has been tested in vitro, in animal models, and clinically for its efficacy in enhancing the rate of wound healing, reducing pain associated with injuries, and promoting axon regeneration. Although extensive data indicate that PRP-released factors induce these effects, the claims are often weakened because many studies were not rigorous or controlled, the data were limited, and other studies yielded contrary results. Critical to assessing whether PRP is effective are the large number of variables in these studies, including the method of PRP preparation, which influences the composition of PRP; type of application; type of wounds; target tissues; and diverse animal models and clinical studies. All these variables raise the question of whether one can anticipate consistent influences and raise the possibility that most of the results are correct under the circumstances where PRP was tested. This review examines evidence on the potential influences of PRP and whether PRP-released factors could induce the reported influences and concludes that the preponderance of evidence suggests that PRP has the capacity to induce all the claimed influences, although this position cannot be definitively argued. Well-defined and rigorously controlled studies of the potential influences of PRP are required in which PRP is isolated and applied using consistent techniques, protocols, and models. Finally, it is concluded that, because of the purported benefits of PRP administration and the lack of adverse events, further animal and clinical studies should be performed to explore the potential influences of PRP.

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Section: Factors From Platelet-rich Plasmamentioning

confidence: 99%

Platelet-Rich Plasma Promotes Axon Regeneration, Wound Healing, and Pain Reduction: Fact or Fiction

Kuffler

2015

Mol Neurobiol

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“…More recently, an anterior site, related to injury to the perineal and compression of the dorsal branch of the pudendal nerve, has been reported for pudendal nerve symptoms that do not include rectal pain [18]. Another possible source of failure of transgluteal pudendal decompression is the belief that the STL should be reconstructed due to its importance in pelvic stability [14, 15]. A review of the critical biomechanical studies that have been done relating the STL and the sacrospinous ligament to pelvic stability demonstrates that all of the four studies used cadavers, appropriate experimental methods, engineering principles, and showed that in the total of 35 pelvises the sequential division of the STL and sacrospinous ligament did not have any effect on pelvic stability, which was maintained by the much stronger and more important anterior and posterior sacroiliac ligaments [19–23].…”

Section: Discussionmentioning

confidence: 99%

“…Following STL release for neurolysis of the PN, sacroiliac joint pain/dysfunction has been reported to occur [10, 11]. Attempts to reconstruct the transverse carpal ligament have been included in the neurolysis of the median nerve to prevent pillar pain [12, 13], and attempts have now been reported to reconstruct the STL following pudendal neurolysis [14, 15]. If post-operative imaging of the STL demonstrated that this ligament, like the transverse carpal ligament, also reformed, or “healed”, but that the PN demonstrated a more normal physiologic appearance post-operatively, then there would be evidence in support of not reconstructing the STL.…”

Section: Introductionmentioning

confidence: 99%

Sacrotuberous Ligament Healing following Surgical Division during Transgluteal Pudendal Nerve Decompression: A 3-Tesla MR Neurography Study

Fritz

Dellon

2016

PLoS ONE

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Pelvic pain due to chronic pudendal nerve (PN) compression, when treated surgically, is approached with a transgluteal division of the sacrotuberous ligament (STL). Controversy exists as to whether the STL heals spontaneously or requires grafting. Therefore, the aim of this study was to determine how surgically divided and unrepaired STL heal. A retrospective evaluation of 10 patients who had high spatial resolution 3-Tesla magnetic resonance imaging (3T MRI) exams of the pelvis was done using an IRB-approved protocol. Each patient was referred for residual pelvic pain after a transgluteal STL division for chronic pudendal nerve pain. Of the 10 patients, 8 had the STL divided and not repaired, while 2 had the STL divided and reconstructed with an allograft tendon. Of the 8 that were left unrepaired, 6 had bilateral surgery. Outcome variables included STL integrity and thickness. Normative data for the STL were obtained through a control group of 20 subjects. STL integrity and thickness were measured directly on 3 T MR Neurography images, by two independent Radiologists. The integrity and thickness of the post-surgical STL was evaluated 39 months (range, 9–55) after surgery. Comparison was made with the native contra-lateral STL in those who had unilateral STL division, and with normal, non-divided STL of subjects of the control group. The normal STL measured 3 mm (minimum and maximum of absolute STL thickness, 2–3 mm). All post-operative STL were found to be continuous regardless of the surgical technique used. Measured at level of Alcock’s canal in the same plane as the obturator internus tendon posterior to the ischium, the mean anteroposterior STL diameter was 5 mm (range, 4–5 mm) in the group of prior STL division without repair and 8 mm (range, 8–9 mm) in the group with the STL reconstructed with grafts (p<0.05). The group of healed STLs were significantly thicker than the normal STL (p<0.05). We conclude that a surgically divided STL will heal spontaneously and will be significantly thicker after healing.

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“…The pudendal nerve is then decompressed along its entire length, from the piriformis muscle to Alcock's canal. Some centers describe encasing the nerve in nerve protective sheath and using platelet-rich plasma to promote healing and decrease scar formation [22,23].…”

Section: Surgery For Genital Pain Caused By Pudendal Neuralgiamentioning

confidence: 99%

Current Uses of Surgery in the Treatment of Genital Pain

King

Rubin

Goldstein

2014

Curr Sex Health Rep

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Genital pain frequently causes sexual dysfunction and psychological distress that can impact every aspect of a woman's life. When conservative medical treatments do not adequately treat the genital pain, surgical procedures have the potential to significantly decrease the pain. The following review examines surgical procedures currently being used to treat pudendal neuralgia, scarring from lichen sclerosus, and provoked vestibulodynia. In addition, a diagnostic algorithm is included that can be used to identify specific causes of genital pain and to determining when surgery is an appropriate treatment option.

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Repeat Operation for Treatment of Persistent Pudendal Nerve Entrapment After Pudendal Neurolysis

Cited by 37 publications

References 11 publications

Platelet-Rich Plasma Promotes Axon Regeneration, Wound Healing, and Pain Reduction: Fact or Fiction

Platelet-Rich Plasma Promotes Axon Regeneration, Wound Healing, and Pain Reduction: Fact or Fiction

Sacrotuberous Ligament Healing following Surgical Division during Transgluteal Pudendal Nerve Decompression: A 3-Tesla MR Neurography Study

Current Uses of Surgery in the Treatment of Genital Pain

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