Shafik A
Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Egypt.
Eur J Obstet Gynecol Reprod Biol. 1998 Oct;80(2):215-20. doi: 10.1016/s0301-2115(98)00110-9.
Notwithstanding many established causes of vulvodynia there still remains an idiopathic group with unknown etiology and variable results of treatment. We present 11 women with idiopathic vulvodynia in whom the etiology could be defined and who were successfully treated. Age varied from 28-53 years. The vulvar pain was associated with stress urinary incontinence in 6/11 patients and all had constipation. Perineal and vulvar hypoesthesia occurred in 6, weak anal reflex in 7 and diminished EMG activity of the external anal sphincter in 3, of the external urethral sphincter in 6 and of the levator ani muscle in 11. There was significant increase (P<0.05) of the pudendal nerve terminal motor latency (PNTML) in all. The motor and sensory change as well as the increased PNTML point to pudendal canal syndrome. Pudendal nerve block, as a diagnostic and therapeutic test, effected temporary pain relief. Pudendal nerve decompression was performed. The inferior rectal nerve was exposed through a para-anal incision, and followed to the pudendal nerve in the pudendal canal. Pudendal canal fasciotomy was done to release the pudendal nerve in the ischiorectal fossa. Vulvar pain disappeared in 9/11 women and stress urinary incontinence in 4/6. Anal reflex was normalized in 5/7 women, and vulvar and perineal hypoesthesia in 4/6. The EMG activity of the external urethral sphincter improved in 4/6, of the external anal sphincter in 2/3 and of the levator ani in 9/11 women. The PNTML was normalized in 9/11 women. In conclusion, pudendal nerve decompression effected relief and improvement in the sensory and motor manifestations of the pudendal nerve in 9/11 women. Two women did not improve due probably to an irreversible damage of the pudendal nerve, or to incomplete pudendal nerve decompression.
尽管外阴痛已有多种明确的病因，但仍存在一组病因不明且治疗效果各异的特发性病例。我们报告了11例特发性外阴痛患者，其病因得以明确且均获成功治疗。年龄范围为28至53岁。11例患者中有6例的外阴疼痛与压力性尿失禁相关，且所有患者均有便秘。6例出现会阴及外阴感觉减退，7例肛门反射减弱，3例肛门外括约肌肌电图活动减弱，6例尿道外括约肌肌电图活动减弱，11例肛提肌肌电图活动减弱。所有人的阴部神经终末运动潜伏期（PNTML）均显著延长（P<0.05）。运动和感觉变化以及PNTML延长提示阴部管综合征。阴部神经阻滞作为一种诊断和治疗性试验，可使疼痛暂时缓解。遂行阴部神经减压术。经肛门旁切口暴露直肠下神经，然后追踪至阴部管内的阴部神经。在坐骨直肠窝行阴部管筋膜切开术以松解阴部神经。11例患者中有9例外阴疼痛消失，6例中有4例压力性尿失禁消失。7例中有5例肛门反射恢复正常，6例中有4例会阴及外阴感觉减退改善。6例中有4例尿道外括约肌肌电图活动改善，3例中有2例肛门外括约肌肌电图活动改善，11例中有9例肛提肌肌电图活动改善。11例中有9例PNTML恢复正常。总之，阴部神经减压术使11例患者中的9例阴部神经的感觉和运动表现得到缓解和改善。2例患者未改善，可能是由于阴部神经发生不可逆损伤，或阴部神经减压不完全。
