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Laparoscopic transperitoneal pudendal nerve and artery release for pudendal entrapment syndrome

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Abstract

Introduction

Pudendal nerve and artery entrapment is an underdiagnosed pathology responsible of several urinary, sexual and anorectal complaints. The aim of our study was to evaluate safety and feasibility of laparoscopic transperitoneal pudendal nerve and artery release in a large retrospective cohort of patients with pudendal nerve entrapment syndrome with both a short and long-term follow-up. Technical details and outcomes are also reported.

Methods

A series of 235 patients with pudendal syndrome underwent laparoscopic transperitoneal pudendal canal release between June 2015 and February 2020. Operative data were recorded prospectively for all patients. A complete history, pain visual analog scale (VAS) for perineodynia, and three scores evaluating the main symptoms (USP, IIEF-5, PAC-SYM) were obtained before and at least 24 months after surgery for 32 patients only. Post-operative complications were also evaluated using Clavien-Dindo classification at regular interval.

Results

The mean operating time per side was 33.9 ± 6.8 min and the average hospital stay was 1.9 ± 0.3 days. Blood loss was 20 cc ± 10 cc with no patients needing transfusion. The only significant per-operative complication was hemorrhage (600 ml) in one patient induced by a pudendal artery laceration, successfully treated by laparoscopic suturing. Post-operative complications were noted in 18.7% of patients with no serious Clavien-Dindo complications. Perineodynia VAS dropped from 6.8 ± 0.9 to 2.2 ± 1.8 after surgery (p < 0.001). Mean IIEF-5 scores significantly improved one month after the surgery (15.2 vs 19.3, p = 0.036). Mean USP scores significantly improved for the dysuria domain (4.2 vs 1.6, p = 0.021) but not for stress urinary incontinence (3.9 vs 4.1, p = 0.082) or overactive bladder symptoms (14.1 vs 13.8, p = 0.079). Mean PAC-SYM scores significantly improved after the procedure (1.8 vs 1.1, p < 0.001).

Conclusion

A complete laparoscopic pudendal nerve and artery release, from the sciatic spine through the Alcock’s canal, is a fast and safe surgery with promising functional results. A large prospective trial is needed to validate such an approach.

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Funding

This study did not receive any funding.

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Authors and Affiliations

  1. Wallonie Picarde Hospital, Tournai, Belgium

    Renaud Bollens

  2. Department of Urology, Université Nord de France, St Phillibert Hospital, Lille, France

    Renaud Bollens

  3. Hotel-Dieu de France, Université Saint Joseph, Beirut, Lebanon

    Georges Mjaess, Julien Sarkis, Anthony Kallas Chemaly, Elie Nemr, Albert Semaan, Josselin Abi Chebel & Fouad Aoun

  4. Rizk Hospital (LAU Medical Center), Beirut, Lebanon

    Karim Daher

  5. Gynecology Department, EpiCURA Hospital, Ath, Belgium

    Fabienne Absil

  6. Urology Department, Institut Jules Bordet, Brussels, Belgium

    Fouad Aoun

Authors
  1. Renaud Bollens
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  2. Georges Mjaess
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  3. Julien Sarkis
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  4. Anthony Kallas Chemaly
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  5. Elie Nemr
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  6. Karim Daher
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  7. Albert Semaan
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  8. Josselin Abi Chebel
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  9. Fabienne Absil
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  10. Fouad Aoun
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Correspondence to Fouad Aoun.

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Disclosures

R.B., G.M., J.S., K.D., A.K.C., A.S., F. Ab, F. Ao declares that they have no conflict of interest or financial ties to disclose.

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Bollens, R., Mjaess, G., Sarkis, J. et al. Laparoscopic transperitoneal pudendal nerve and artery release for pudendal entrapment syndrome. Surg Endosc 35, 6031–6038 (2021). https://doi.org/10.1007/s00464-020-08092-4

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  • DOI: https://doi.org/10.1007/s00464-020-08092-4

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