Dellon A Lee, Wright E James, Manson Paul N
Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland.
Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Reconstr Microsurg. 2014 Oct;30(8):547-50. doi: 10.1055/s-0033-1361844. Epub 2014 Feb 17.
Development of chronic pelvic pain after laser resection for benign prostatic hypertrophy has not been described previously (Clavien IIIb complication). The etiology of this chronic pain, which persisted despite medical chronic pain and urologic management for 5 years, was proven to be of pudendal nerve origin by local anesthetic blockade of the pudendal nerves bilaterally at the ischial spines. Surgical treatment was based upon the anatomic proximity of the perineal and dorsal branches of the pudendal nerve to the site of laser therapy on the pelvic side of the urogenital diaphragm. Treatment required resection of the perineal branches of the pudendal nerve bilaterally and neurolysis of the dorsal nerve to the penis bilaterally through incisions overlying the inferior pubic ramus. Relief of perineal pain and pain with micturition occurred in the immediate postoperative period. Pain relief and resumption of all normal activity occurred by 3 months postoperatively and continues 13 months following the surgery.
此前未曾有过关于良性前列腺增生激光切除术后慢性盆腔疼痛的报道（Clavien IIIb级并发症）。尽管进行了5年的慢性疼痛医学治疗和泌尿外科处理，这种慢性疼痛仍持续存在，通过在坐骨棘水平双侧对阴部神经进行局部麻醉阻滞，证实其病因源于阴部神经。手术治疗基于阴部神经的会阴支和背侧支在解剖学上与泌尿生殖膈盆腔侧激光治疗部位的接近程度。治疗需要双侧切除阴部神经的会阴支，并通过耻骨下支上方的切口双侧对阴茎背神经进行神经松解术。术后即刻出现会阴疼痛和排尿疼痛缓解。术后3个月疼痛缓解，所有正常活动恢复，术后13个月仍持续缓解。
