Department of Gynecology and Obstetrics, University Hospital of Liège, Liège, Belgium.
Department of Gynecology and Obstetrics, CHC Clinique Sainte Elisabeth, Heusy, Belgium.
Surg Endosc. 2018 Aug;32(8):3720-3731. doi: 10.1007/s00464-018-6239-4. Epub 2018 May 23.
Pudendal nerve entrapment can produce a pudendal syndrome comprising perineodynia together with urinary, sexual, and anorectal symptoms. This syndrome can be treated surgically by the transperineal approach. By using an endoscope during the procedure ("operative pudendoscopy"), the surgeon has close-up visual control of each decompression steps, demonstrates the different levels of entrapment, and cuts the sacrospinous ligament under visual control. The aim of this study was to describe the technical details of this new technique and its outcome in the treatment of the pudendal syndrome.
A series of 113 patients with severe pudendal syndrome underwent operative pudendoscopy. A complete history, pain visual analog scale (VAS) for perineodynia, and four scores evaluating the main symptoms (ICIQ-SF, NHI-CPSI, St Mark's, and Wexner) were obtained before and at least 24 months after surgery. The three clinical signs of pudendal syndrome (abnormal pinprick sensitivity, painful skin rolling test, and painful pudendal nerve) and perineal descent were analyzed before and after surgery in 91 patients.
The mean operating time per side was 50.3 ± 15.2 min and the average hospital stay was 2.1 ± 0.4 days. Perineodynia VAS dropped from 7.2 ± 1.4 to 4.5 ± 2.9 after surgery (p < 0.0001) and the symptoms scores significantly improved. Frequency of sexual arousal syndrome, dyspareunia, and cystalgia was also significantly reduced. Pathological perineal descent (≥ 1.5 cm measured with a Perineocaliper®) observed in 13 patients was reduced from 1.81 to 0.77 cm after surgery (p < 0.0001). The only significant complication was severe hemorrhage in one patient induced by an inferior gluteal vessel laceration and successfully treated by arterial embolization.
A complete pudendal nerve decompression, from the distal branches to the sacral foramina, safely performed under visual control by using operative pudendoscopy markedly improves clinical signs and symptoms of the pudendal syndrome.
阴部神经受压可导致阴部综合征，表现为会阴痛，并伴有泌尿、性功能和肛肠症状。该综合征可通过经会阴入路手术治疗。在手术过程中使用内镜（“手术阴部镜检查”），外科医生可以近距离观察每个减压步骤，显示不同的受压水平，并在视觉控制下切开骶棘韧带。本研究旨在描述这种新技术的技术细节及其在阴部综合征治疗中的效果。
对 113 例严重阴部综合征患者进行了手术阴部镜检查。所有患者术前均行完整病史采集、会阴痛视觉模拟评分（VAS）以及四项主要症状评分（ICIQ-SF、NHI-CPSI、St Mark's 和 Wexner），术后至少 24 个月时再次进行评估。91 例患者术前和术后均行阴部综合征的三个临床体征（异常刺痛觉、滚动皮肤痛觉试验和阴部神经痛觉）和会阴下降分析。
每侧手术的平均时间为 50.3±15.2 分钟，平均住院时间为 2.1±0.4 天。术后会阴痛 VAS 从 7.2±1.4 降至 4.5±2.9（p<0.0001），症状评分显著改善。性唤起综合征、性交痛和膀胱炎的发生率也显著降低。用 Perineocaliper®测量，术前 13 例患者存在的病理性会阴下降（≥1.5cm）术后降至 0.77cm（p<0.0001）。唯一的严重并发症是 1 例患者因臀下血管撕裂导致严重出血，经动脉栓塞成功治疗。
通过手术阴部镜检查进行的安全可视的阴部神经全程减压术（从远端分支到骶孔）可显著改善阴部综合征的临床体征和症状。
