阴部神经调节在阴部神经受压手术后是可行且有效的。

Pudendal Neuromodulation is Feasible and Effective After Pudendal Nerve Entrapment Surgery.

机构信息

Beaumont Health, Department of Urology, Royal Oak, MI, USA.

Oakland University William Beaumont School of Medicine, Rochester, MI, USA.

出版信息

J Sex Med. 2022 Jun;19(6):995-1001. doi: 10.1016/j.jsxm.2022.03.219. Epub 2022 Apr 19.

DOI:10.1016/j.jsxm.2022.03.219

PMID:35459633

Abstract

BACKGROUND

Patients with intractable pain in the pudendal nerve distribution may benefit from pudendal neuromodulation; however, some may have previously undergone pudendal nerve entrapment surgery (PNES), potentially altering nerve anatomy and function.

AIM

We examined pudendal neuromodulation outcomes in patients with prior PNES.

METHODS

Patients with a history of PNES and quadripolar, tined pudendal lead placement for urogenital pain were reviewed. Symptoms and outcomes were collected from existing medical records.

OUTCOMES

Patients with pudendal neuromodulation and prior PNES were compared to patients with no prior PNES who had pudendal lead placement.

RESULTS

Fifteen patients with a history of 1, 2, or 3 prior PNES (n = 13, 1, and 1, respectively) were evaluated. Most (10; 67%) were female, with bilateral pain (9; 60%), and symptoms of 5-26 years. After trialing the lead, bladder symptoms and pain were improved in 8 of 12 and 9 of 14 patients, respectively, and 80% of patients (12/15) underwent permanent generator implantation. When prior PNES patients were compared to those with no prior PNES (n = 43), gender (67% vs 77% female; P = .50) and age (median 63 vs 58 years; P = .80), were similar; however, BMI differed (mean 24 vs 29; P = .008) and a lower proportion (12/15; 80% vs 42/43; 98%; P = .049) had generator implantation. Importantly, median lead implant time (48 vs 50 minutes; P = .65) did not differ between the 2 groups.

CLINICAL IMPLICATIONS

Pudendal neuromodulation has the potential to provide pain relief for a very difficult-to-treat population; furthermore, it does not appear that prior PNES surgery made lead placement significantly more challenging.

STRENGTHS & LIMITATIONS: Study strengths include being a tertiary referral center for urogenital pain and having a single surgeon perform all procedures in a regimented way. Limitations include the retrospective study design, small sample size and various approaches to PN CONCLUSION: Chronic pudendal neuromodulation can be a viable option even after prior PNES. Kristen M. Meier, Patrick M. Vecellio, Kim A. Killinger, Judith A. Boura, Kenneth M. Peters. Pudendal Neuromodulation is Feasible and Effective After Pudendal Nerve Entrapment Surgery. J Sex Med 2022;19:995-1001.

摘要

背景

阴部神经分布区顽固性疼痛的患者可能受益于阴部神经调节；然而，一些患者可能先前接受过阴部神经卡压手术（PNES），这可能改变了神经解剖和功能。

目的

我们研究了有阴部神经卡压手术史的患者进行阴部神经调节的结果。

方法

对有阴部神经卡压病史且行四极、带叉阴部引线植入术治疗泌尿生殖疼痛的患者进行了回顾。从现有的病历中收集了症状和结果。

结果

评估了 15 名有 1、2 或 3 次阴部神经卡压手术史的患者（n=13、1 和 1，分别）。大多数（10 例；67%）为女性，双侧疼痛（9 例；60%），症状持续 5-26 年。在试用引线后，12 例患者中的 8 例和 14 例患者中的 9 例的膀胱症状和疼痛得到改善，80%的患者（12/15）接受了永久性发生器植入。将有阴部神经卡压手术史的患者与无阴部神经卡压手术史的患者（n=43）进行比较，性别（67%比 77%为女性；P=0.50）和年龄（中位数 63 岁比 58 岁；P=0.80）相似；然而，体重指数不同（平均 24 比 29；P=0.008），植入发生器的比例较低（15 例中的 12 例[80%]比 43 例中的 42 例[98%]；P=0.049）。重要的是，两组之间的引线植入时间中位数（48 分钟比 50 分钟；P=0.65）没有差异。

临床意义

阴部神经调节有可能为治疗非常困难的人群提供疼痛缓解；此外，阴部神经卡压手术似乎并没有使引线放置变得更加困难。

优势与局限性

研究的优势包括作为泌尿生殖疼痛的三级转诊中心以及由一位外科医生以规范的方式进行所有手术。局限性包括回顾性研究设计、样本量小以及阴部神经卡压手术的各种方法。

结论

即使在阴部神经卡压手术后，慢性阴部神经调节仍然是可行的选择。Kristen M. Meier、Patrick M. Vecellio、Kim A. Killinger、Judith A. Boura、Kenneth M. Peters。阴部神经卡压手术后行阴部神经调节是可行和有效的。《性医学杂志》2022；19：995-1001。