Laparoscopic transperitoneal pudendal nerve and artery release for pudendal entrapment syndrome
Introduction Pudendal nerve and artery entrapment is an underdiagnosed pathology responsible of several urinary, sexual and anorectal complaints. The aim of our study was to evaluate safety and feasibility of laparoscopic transperitoneal pudendal nerve and artery release in a large retrospective coh...
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| Veröffentlicht in: | Surgical endoscopy 2021-11, Vol.35 (11), p.6031-6038 |
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| creator | Bollens, Renaud Mjaess, Georges Sarkis, Julien Chemaly, Anthony Kallas Nemr, Elie Daher, Karim Semaan, Albert Chebel, Josselin Abi Absil, Fabienne Aoun, Fouad |
| description | Introduction
Pudendal nerve and artery entrapment is an underdiagnosed pathology responsible of several urinary, sexual and anorectal complaints. The aim of our study was to evaluate safety and feasibility of laparoscopic transperitoneal pudendal nerve and artery release in a large retrospective cohort of patients with pudendal nerve entrapment syndrome with both a short and long-term follow-up. Technical details and outcomes are also reported.
Methods
A series of 235 patients with pudendal syndrome underwent laparoscopic transperitoneal pudendal canal release between June 2015 and February 2020. Operative data were recorded prospectively for all patients. A complete history, pain visual analog scale (VAS) for perineodynia, and three scores evaluating the main symptoms (USP, IIEF-5, PAC-SYM) were obtained before and at least 24 months after surgery for 32 patients only. Post-operative complications were also evaluated using Clavien-Dindo classification at regular interval.
Results
The mean operating time per side was 33.9 ± 6.8 min and the average hospital stay was 1.9 ± 0.3 days. Blood loss was 20 cc ± 10 cc with no patients needing transfusion. The only significant per-operative complication was hemorrhage (600 ml) in one patient induced by a pudendal artery laceration, successfully treated by laparoscopic suturing. Post-operative complications were noted in 18.7% of patients with no serious Clavien-Dindo complications. Perineodynia VAS dropped from 6.8 ± 0.9 to 2.2 ± 1.8 after surgery (
p
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| doi_str_mv | 10.1007/s00464-020-08092-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2450648122</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2450648122</sourcerecordid><originalsourceid>FETCH-LOGICAL-c352t-c8d1ef73d66a54f2117a35749a7eeb6d05aa7ee8555f8df9a4cf04de55f950313</originalsourceid><addsrcrecordid>eNp9kE1LxDAQhoMouK7-AU8FL16ik6-2OcriFyx40XOIzUS6tGlNWmH_vVlXWPDgaWbgeV-Gh5BLBjcMoLpNALKUFDhQqEFzKo_IgknBKeesPiYL0AIor7Q8JWcpbSDzmqkFMWs72jikZhjbppiiDWnE2E5DQNsV4-wwuLwEjF9Y2OAKGyeM2yJihzZh4Yd4oDDkgrHPo0jb4OLQ4zk58bZLePE7l-Tt4f519UTXL4_Pq7s1bYTiE21qx9BXwpWlVdJzxiorVCW1rRDfSwfK7rZaKeVr57WVjQfpMJ9agWBiSa73vWMcPmdMk-nb1GDX2YDDnAyXCkpZM84zevUH3QxzDPk7w1XNa801rzLF91ST7aSI3oyx7W3cGgZm59zsnZvs3Pw4NzKHxD6UMhw-MB6q_0l9A-M6hew</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2582892927</pqid></control><display><type>article</type><title>Laparoscopic transperitoneal pudendal nerve and artery release for pudendal entrapment syndrome</title><source>SpringerLink Journals - AutoHoldings</source><creator>Bollens, Renaud ; Mjaess, Georges ; Sarkis, Julien ; Chemaly, Anthony Kallas ; Nemr, Elie ; Daher, Karim ; Semaan, Albert ; Chebel, Josselin Abi ; Absil, Fabienne ; Aoun, Fouad</creator><creatorcontrib>Bollens, Renaud ; Mjaess, Georges ; Sarkis, Julien ; Chemaly, Anthony Kallas ; Nemr, Elie ; Daher, Karim ; Semaan, Albert ; Chebel, Josselin Abi ; Absil, Fabienne ; Aoun, Fouad</creatorcontrib><description>Introduction
Pudendal nerve and artery entrapment is an underdiagnosed pathology responsible of several urinary, sexual and anorectal complaints. The aim of our study was to evaluate safety and feasibility of laparoscopic transperitoneal pudendal nerve and artery release in a large retrospective cohort of patients with pudendal nerve entrapment syndrome with both a short and long-term follow-up. Technical details and outcomes are also reported.
Methods
A series of 235 patients with pudendal syndrome underwent laparoscopic transperitoneal pudendal canal release between June 2015 and February 2020. Operative data were recorded prospectively for all patients. A complete history, pain visual analog scale (VAS) for perineodynia, and three scores evaluating the main symptoms (USP, IIEF-5, PAC-SYM) were obtained before and at least 24 months after surgery for 32 patients only. Post-operative complications were also evaluated using Clavien-Dindo classification at regular interval.
Results
The mean operating time per side was 33.9 ± 6.8 min and the average hospital stay was 1.9 ± 0.3 days. Blood loss was 20 cc ± 10 cc with no patients needing transfusion. The only significant per-operative complication was hemorrhage (600 ml) in one patient induced by a pudendal artery laceration, successfully treated by laparoscopic suturing. Post-operative complications were noted in 18.7% of patients with no serious Clavien-Dindo complications. Perineodynia VAS dropped from 6.8 ± 0.9 to 2.2 ± 1.8 after surgery (
p
< 0.001). Mean IIEF-5 scores significantly improved one month after the surgery (15.2 vs 19.3,
p
= 0.036). Mean USP scores significantly improved for the dysuria domain (4.2 vs 1.6,
p
= 0.021) but not for stress urinary incontinence (3.9 vs 4.1,
p
= 0.082) or overactive bladder symptoms (14.1 vs 13.8,
p
= 0.079). Mean PAC-SYM scores significantly improved after the procedure (1.8 vs 1.1,
p
< 0.001).
Conclusion
A complete laparoscopic pudendal nerve and artery release, from the sciatic spine through the Alcock’s canal, is a fast and safe surgery with promising functional results. A large prospective trial is needed to validate such an approach.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-020-08092-4</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Bladder ; Constipation ; Endoscopy ; Gastroenterology ; Gynecology ; Hepatology ; Hospitals ; Laparoscopy ; Males ; Medicine ; Medicine & Public Health ; Pain ; Patients ; Proctology ; Reproducibility ; Surgery ; Urology ; Veins & arteries</subject><ispartof>Surgical endoscopy, 2021-11, Vol.35 (11), p.6031-6038</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c352t-c8d1ef73d66a54f2117a35749a7eeb6d05aa7ee8555f8df9a4cf04de55f950313</citedby><cites>FETCH-LOGICAL-c352t-c8d1ef73d66a54f2117a35749a7eeb6d05aa7ee8555f8df9a4cf04de55f950313</cites><orcidid>0000-0002-8703-4611</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-020-08092-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-020-08092-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids></links><search><creatorcontrib>Bollens, Renaud</creatorcontrib><creatorcontrib>Mjaess, Georges</creatorcontrib><creatorcontrib>Sarkis, Julien</creatorcontrib><creatorcontrib>Chemaly, Anthony Kallas</creatorcontrib><creatorcontrib>Nemr, Elie</creatorcontrib><creatorcontrib>Daher, Karim</creatorcontrib><creatorcontrib>Semaan, Albert</creatorcontrib><creatorcontrib>Chebel, Josselin Abi</creatorcontrib><creatorcontrib>Absil, Fabienne</creatorcontrib><creatorcontrib>Aoun, Fouad</creatorcontrib><title>Laparoscopic transperitoneal pudendal nerve and artery release for pudendal entrapment syndrome</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><description>Introduction
Pudendal nerve and artery entrapment is an underdiagnosed pathology responsible of several urinary, sexual and anorectal complaints. The aim of our study was to evaluate safety and feasibility of laparoscopic transperitoneal pudendal nerve and artery release in a large retrospective cohort of patients with pudendal nerve entrapment syndrome with both a short and long-term follow-up. Technical details and outcomes are also reported.
Methods
A series of 235 patients with pudendal syndrome underwent laparoscopic transperitoneal pudendal canal release between June 2015 and February 2020. Operative data were recorded prospectively for all patients. A complete history, pain visual analog scale (VAS) for perineodynia, and three scores evaluating the main symptoms (USP, IIEF-5, PAC-SYM) were obtained before and at least 24 months after surgery for 32 patients only. Post-operative complications were also evaluated using Clavien-Dindo classification at regular interval.
Results
The mean operating time per side was 33.9 ± 6.8 min and the average hospital stay was 1.9 ± 0.3 days. Blood loss was 20 cc ± 10 cc with no patients needing transfusion. The only significant per-operative complication was hemorrhage (600 ml) in one patient induced by a pudendal artery laceration, successfully treated by laparoscopic suturing. Post-operative complications were noted in 18.7% of patients with no serious Clavien-Dindo complications. Perineodynia VAS dropped from 6.8 ± 0.9 to 2.2 ± 1.8 after surgery (
p
< 0.001). Mean IIEF-5 scores significantly improved one month after the surgery (15.2 vs 19.3,
p
= 0.036). Mean USP scores significantly improved for the dysuria domain (4.2 vs 1.6,
p
= 0.021) but not for stress urinary incontinence (3.9 vs 4.1,
p
= 0.082) or overactive bladder symptoms (14.1 vs 13.8,
p
= 0.079). Mean PAC-SYM scores significantly improved after the procedure (1.8 vs 1.1,
p
< 0.001).
Conclusion
A complete laparoscopic pudendal nerve and artery release, from the sciatic spine through the Alcock’s canal, is a fast and safe surgery with promising functional results. A large prospective trial is needed to validate such an approach.</description><subject>Abdominal Surgery</subject><subject>Bladder</subject><subject>Constipation</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hospitals</subject><subject>Laparoscopy</subject><subject>Males</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Pain</subject><subject>Patients</subject><subject>Proctology</subject><subject>Reproducibility</subject><subject>Surgery</subject><subject>Urology</subject><subject>Veins & arteries</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kE1LxDAQhoMouK7-AU8FL16ik6-2OcriFyx40XOIzUS6tGlNWmH_vVlXWPDgaWbgeV-Gh5BLBjcMoLpNALKUFDhQqEFzKo_IgknBKeesPiYL0AIor7Q8JWcpbSDzmqkFMWs72jikZhjbppiiDWnE2E5DQNsV4-wwuLwEjF9Y2OAKGyeM2yJihzZh4Yd4oDDkgrHPo0jb4OLQ4zk58bZLePE7l-Tt4f519UTXL4_Pq7s1bYTiE21qx9BXwpWlVdJzxiorVCW1rRDfSwfK7rZaKeVr57WVjQfpMJ9agWBiSa73vWMcPmdMk-nb1GDX2YDDnAyXCkpZM84zevUH3QxzDPk7w1XNa801rzLF91ST7aSI3oyx7W3cGgZm59zsnZvs3Pw4NzKHxD6UMhw-MB6q_0l9A-M6hew</recordid><startdate>20211101</startdate><enddate>20211101</enddate><creator>Bollens, Renaud</creator><creator>Mjaess, Georges</creator><creator>Sarkis, Julien</creator><creator>Chemaly, Anthony Kallas</creator><creator>Nemr, Elie</creator><creator>Daher, Karim</creator><creator>Semaan, Albert</creator><creator>Chebel, Josselin Abi</creator><creator>Absil, Fabienne</creator><creator>Aoun, Fouad</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8703-4611</orcidid></search><sort><creationdate>20211101</creationdate><title>Laparoscopic transperitoneal pudendal nerve and artery release for pudendal entrapment syndrome</title><author>Bollens, Renaud ; Mjaess, Georges ; Sarkis, Julien ; Chemaly, Anthony Kallas ; Nemr, Elie ; Daher, Karim ; Semaan, Albert ; Chebel, Josselin Abi ; Absil, Fabienne ; Aoun, Fouad</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c352t-c8d1ef73d66a54f2117a35749a7eeb6d05aa7ee8555f8df9a4cf04de55f950313</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abdominal Surgery</topic><topic>Bladder</topic><topic>Constipation</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hospitals</topic><topic>Laparoscopy</topic><topic>Males</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Pain</topic><topic>Patients</topic><topic>Proctology</topic><topic>Reproducibility</topic><topic>Surgery</topic><topic>Urology</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bollens, Renaud</creatorcontrib><creatorcontrib>Mjaess, Georges</creatorcontrib><creatorcontrib>Sarkis, Julien</creatorcontrib><creatorcontrib>Chemaly, Anthony Kallas</creatorcontrib><creatorcontrib>Nemr, Elie</creatorcontrib><creatorcontrib>Daher, Karim</creatorcontrib><creatorcontrib>Semaan, Albert</creatorcontrib><creatorcontrib>Chebel, Josselin Abi</creatorcontrib><creatorcontrib>Absil, Fabienne</creatorcontrib><creatorcontrib>Aoun, Fouad</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bollens, Renaud</au><au>Mjaess, Georges</au><au>Sarkis, Julien</au><au>Chemaly, Anthony Kallas</au><au>Nemr, Elie</au><au>Daher, Karim</au><au>Semaan, Albert</au><au>Chebel, Josselin Abi</au><au>Absil, Fabienne</au><au>Aoun, Fouad</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Laparoscopic transperitoneal pudendal nerve and artery release for pudendal entrapment syndrome</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><date>2021-11-01</date><risdate>2021</risdate><volume>35</volume><issue>11</issue><spage>6031</spage><epage>6038</epage><pages>6031-6038</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Introduction
Pudendal nerve and artery entrapment is an underdiagnosed pathology responsible of several urinary, sexual and anorectal complaints. The aim of our study was to evaluate safety and feasibility of laparoscopic transperitoneal pudendal nerve and artery release in a large retrospective cohort of patients with pudendal nerve entrapment syndrome with both a short and long-term follow-up. Technical details and outcomes are also reported.
Methods
A series of 235 patients with pudendal syndrome underwent laparoscopic transperitoneal pudendal canal release between June 2015 and February 2020. Operative data were recorded prospectively for all patients. A complete history, pain visual analog scale (VAS) for perineodynia, and three scores evaluating the main symptoms (USP, IIEF-5, PAC-SYM) were obtained before and at least 24 months after surgery for 32 patients only. Post-operative complications were also evaluated using Clavien-Dindo classification at regular interval.
Results
The mean operating time per side was 33.9 ± 6.8 min and the average hospital stay was 1.9 ± 0.3 days. Blood loss was 20 cc ± 10 cc with no patients needing transfusion. The only significant per-operative complication was hemorrhage (600 ml) in one patient induced by a pudendal artery laceration, successfully treated by laparoscopic suturing. Post-operative complications were noted in 18.7% of patients with no serious Clavien-Dindo complications. Perineodynia VAS dropped from 6.8 ± 0.9 to 2.2 ± 1.8 after surgery (
p
< 0.001). Mean IIEF-5 scores significantly improved one month after the surgery (15.2 vs 19.3,
p
= 0.036). Mean USP scores significantly improved for the dysuria domain (4.2 vs 1.6,
p
= 0.021) but not for stress urinary incontinence (3.9 vs 4.1,
p
= 0.082) or overactive bladder symptoms (14.1 vs 13.8,
p
= 0.079). Mean PAC-SYM scores significantly improved after the procedure (1.8 vs 1.1,
p
< 0.001).
Conclusion
A complete laparoscopic pudendal nerve and artery release, from the sciatic spine through the Alcock’s canal, is a fast and safe surgery with promising functional results. A large prospective trial is needed to validate such an approach.</abstract><cop>New York</cop><pub>Springer US</pub><doi>10.1007/s00464-020-08092-4</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-8703-4611</orcidid></addata></record> |
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| subjects | Abdominal Surgery Bladder Constipation Endoscopy Gastroenterology Gynecology Hepatology Hospitals Laparoscopy Males Medicine Medicine & Public Health Pain Patients Proctology Reproducibility Surgery Urology Veins & arteries |
| title | Laparoscopic transperitoneal pudendal nerve and artery release for pudendal entrapment syndrome |
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