Bautrant E, de Bisschop E, Vaini-Elies V, Massonnat J, Aleman I, Buntinx J, de Vlieger J, Di Constanzo M, Habib L, Patroni G, Siboni S, Céas B, Schiby V, Uglione-Céas M
Centre Libéral Aixois de Réhabilitation Pelvi-périnéale, Le Grand Angle, 4, place Barthélémy Niollon, 13100 Aix-en-Provence.
J Gynecol Obstet Biol Reprod (Paris). 2003 Dec;32(8 Pt 1):705-12.
Clinical signs and symptoms of the pudendal neuralgia are very rich, with a great individual variability. The clinical diagnosis is difficult. It is confirmed or invalidated by the electrophysiologicals tests. Since October 1998 patient selection has been possible using a diagnosis score. Over a four-year period, the diagnosis of pudendal neuralgia was confirmed by electrophysiological investigations in 212 subjects. We rejected 12 patients because of a radiculo-medullary organic etiology. We only describe here cases of women with a peripheral pudendal nerve injury (200 patients). Thirty-eight neuropathies free of canal symptoms (obstetrical, post-traumatic...) were treated by infiltration therapy. The study of a total of 162 canal syndromes showed prevalent injury at the sacro-spino-tuberal ligamental grip which was observed in 68% of the cases, compared to the Alcock canal which was present in only 20% of the cases. One hundred four of these patients underwent surgical decompression via a trans-ischio-rectal approach after negative results of the infiltration therapy. We report here the surgical methodology, the post-op follow-up and the results, which appear quite successful: after one year 86% of the subjects are symptom-free or with a significant reduction of pain.
