Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery

Object To improve diagnostic accuracy and achieve high levels of treatment success in patients with pudendal nerve entrapment (PNE) syndromes, the author of this study applied advanced technology diagnostics in distinguishing the various syndrome types according to the different entrapment locations and evaluated new minimal access surgical techniques to treat each subtype. Methods Two hundred cases were prospectively evaluated using a standardized set of patient-completed functional and symptom assessments, a collection of new physical examination maneuvers, MR neurography, open MR image–guided injections, intraoperative neurophysiology, minimal access surgery, and formal outcome assessment with the Oswestry Disability Index, pain diagrams, and analog pain scales. Results Four primary types of PNE syndromes were identified based on the different locations of entrapment: Type I, entrapment at the exit of the greater sciatic notch in concert with piriformis muscle spasm; Type II, entrapment at the level of the ischial spine, sacrotuberous ligament, and lesser sciatic notch entrance; Type III, entrapment in association with obturator internus muscle spasm at the entrance of the Alcock canal; and Type IV, distal entrapment of terminal branches. The application of new, targeted minimal access surgical techniques led to sustained good to excellent outcomes (50–100% improvement in the pain score or functional score) in 87% of patients. Most of these patients obtained most of their improvement within 4 weeks of surgery, although some continued to experience progressive improvements up to 12 months after surgery. Conclusions The application of advanced diagnostics to categorize PNE syndrome origins into 4 major subtypes and the subsequent treatment of each subtype with a tailored strategy greatly improved therapeutic outcomes as compared with those reported when only a single treatment paradigm was applied to all patients.

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The Centre for Minimal Access Surgery—teaching for tomorrow

Journal of Telemedicine and Telecare ◽

10.1258/1357633001935798 ◽

2000 ◽

Vol 6 (2_suppl) ◽

pp. 14-15 ◽

Cited By ~ 1

Author(s):

Lianne Durst

Keyword(s):

Skill Acquisition ◽

Surgical Procedures ◽

Surgical Techniques ◽

The Body ◽

Minimal Access Surgery ◽

Research Centre ◽

Minimal Access ◽

Technological Education ◽

Human Form ◽

Access Surgery

The Centre for Minimal Access Surgery (CMAS) was established as a state-of-the-art multidisciplinary technological education and research centre for minimal access surgical techniques. Up-to-date training models were obtained to facilitate skill acquisition. Among these were the Minimal Access Therapy trainer and the Body Form Simulator, which provide simulations of the human form on which students can practise operative procedures. The CMAS also acquired the MIST Virtual Reality system, a computer program that facilitates the acquisition of laparoscopy skills. Finally, the CMAS compiled a multimedia library of resources. While many skills can be gained in these synthetic and didactic environments, they cannot provide all the preparation necessary to practise competently. To facilitate the realtime observation of surgical procedures and the telementoring process, the CMAS has commissioned the development of an integrated videoconferencing system that permits the high-quality, rapid transfer of multi-feed video and audio data of surgical procedures from an operating room to the classroom.

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