Giulioni Carlo, Pirola Giacomo Maria, Maggi Martina, Pitoni Lucia, Fuligni Demetra, Beltrami Mattia, Palantrani Vanessa, De Stefano Virgilio, Maurizi Valentina, Castellani Daniele, Galosi Andrea Benedetto
Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy.
Departmant of Urology, San Giuseppe Hospital, Multimedica Group, Milano, Italy.
Int Neurourol J. 2024 Mar;28(1):11-21. doi: 10.5213/inj.2448010.005. Epub 2024 Mar 31.
To assess the effectiveness and safety of various techniques of pudendal nerve neurolysis (PNN) in patients with pudendal nerve entrapment (PNE). A comprehensive literature search was conducted on May 20th, 2023, using Scopus, PubMed, and Embase databases. Only studies in English involving adults were accepted, while meeting abstracts and preclinical studies were excluded. A total of 34 papers were included. Transperineal PNN emerged as a promising technique, demonstrating significant potential in alleviating pain, restoring erectile function in males, and improving the resolution of urinary stress incontinence in females. Furthermore, the bilateral approach consistently yielded positive outcomes in addressing urinary symptoms. The transgluteal technique appeared particularly suitable for cases of posterior PNE, situated between the sacrospinous ligament and the lesser sciatic foramen. A progressive amelioration of painful symptoms was observed during follow-up. Minimally invasive PNN is evolving and enables decompression along the entire proximal tract up to the Alcock canal, minimizing the risk of comorbidities. In addition to reducing pudendal neuralgia, robot-assisted and laparoscopic approaches determined a reduction in lower urinary tract symptoms and an improvement in erectile function, though further studies are required to corroborate these findings. PNN emerges as an effective treatment for PNE with minimal morbidity. Therefore, PNN should be tailored according to the site of PNE to enhance functional outcomes and improve patient quality of life.
评估各种阴部神经松解术（PNN）治疗阴部神经卡压（PNE）患者的有效性和安全性。于2023年5月20日使用Scopus、PubMed和Embase数据库进行了全面的文献检索。仅纳入英文的成人研究，排除会议摘要和临床前研究。共纳入34篇论文。经会阴PNN成为一种有前景的技术，在缓解疼痛、恢复男性勃起功能以及改善女性压力性尿失禁症状方面显示出巨大潜力。此外，双侧入路在解决泌尿系统症状方面始终取得积极效果。经臀技术似乎特别适用于位于骶棘韧带和坐骨小孔之间的后部PNE病例。随访期间观察到疼痛症状逐渐改善。微创PNN正在不断发展，能够沿整个近端路径直至阿尔科克管进行减压，将合并症风险降至最低。除了减轻阴部神经痛外，机器人辅助和腹腔镜手术方法还能减轻下尿路症状并改善勃起功能，不过还需要进一步研究来证实这些发现。PNN是一种治疗PNE的有效方法，发病率极低。因此，应根据PNE的部位调整PNN，以提高功能效果并改善患者生活质量。
