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[PMID]:28408350
[Au] Autor:Melcangi RC; Santi D; Spezzano R; Grimoldi M; Tabacchi T; Fusco ML; Diviccaro S; Giatti S; Carrà G; Caruso D; Simoni M; Cavaletti G
[Ad] Endereço:Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy. Electronic address: roberto.melcangi@unimi.it.
[Ti] Título:Neuroactive steroid levels and psychiatric and andrological features in post-finasteride patients.
[So] Source:J Steroid Biochem Mol Biol;171:229-235, 2017 Jul.
[Is] ISSN:1879-1220
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Recent reports show that, in patients treated with finasteride for male pattern hair loss, persistent side effects including sexual side effects, depression, anxiety and cognitive complaints may occur. We here explored the psychiatric and andrological features of patients affected by post-finasteride syndrome (PFS) and verified whether the cerebrospinal fluid (CSF) and plasma levels of neuroactive steroids (i.e., important regulators of nervous function) are modified. We found that eight out of sixteen PFS male patients considered suffered from a DSM-IV major depressive disorder (MDD). In addition, all PFS patients showed erectile dysfunction (ED); in particular, ten patients showed a severe and six a mild-moderate ED. We also reported abnormal somatosensory evoked potentials of the pudendal nerve in PFS patients with severe ED, the first objective evidence of a neuropathy involving peripheral neurogenic control of erection. Testicular volume by ultrasonography was normal in PFS patients. Data obtained on neuroactive steroid levels also indicate interesting features. Indeed, decreased levels of pregnenolone, progesterone and its metabolite (i.e., dihydroprogesterone), dihydrotestosterone and 17beta-estradiol and increased levels of dehydroepiandrosterone, testosterone and 5alpha-androstane-3alpha,17beta-diol were observed in CSF of PFS patients. Neuroactive steroid levels were also altered in plasma of PFS patients, however these changes did not reflect exactly what occurs in CSF. Finally, finasteride did not only affect, as expected, the levels of 5alpha-reduced metabolites of progesterone and testosterone, but also the further metabolites and precursors suggesting that this drug has broad consequence on neuroactive steroid levels of PFS patients.
[Mh] Termos MeSH primário: Inibidores de 5-alfa Redutase/efeitos adversos
Transtorno Depressivo Maior/induzido quimicamente
Disfunção Erétil/induzido quimicamente
Finasterida/efeitos adversos
Pregnenolona/líquido cefalorraquidiano
Progesterona/líquido cefalorraquidiano
Testosterona/líquido cefalorraquidiano
[Mh] Termos MeSH secundário: Inibidores de 5-alfa Redutase/uso terapêutico
Adulto
Alopecia/tratamento farmacológico
Estudos de Casos e Controles
Transtorno Depressivo Maior/sangue
Transtorno Depressivo Maior/líquido cefalorraquidiano
Transtorno Depressivo Maior/epidemiologia
Manual Diagnóstico e Estatístico de Transtornos Mentais
Monitoramento de Medicamentos
Disfunção Erétil/epidemiologia
Disfunção Erétil/metabolismo
Disfunção Erétil/fisiopatologia
Potenciais Somatossensoriais Evocados/efeitos dos fármacos
Finasterida/uso terapêutico
Seres Humanos
Incidência
Itália/epidemiologia
Estudos Longitudinais
Masculino
Pregnenolona/sangue
Progesterona/análogos & derivados
Progesterona/sangue
Estudos Prospectivos
Escalas de Graduação Psiquiátrica
Nervo Pudendo/efeitos dos fármacos
Nervo Pudendo/fisiopatologia
Neuralgia do Pudendo/induzido quimicamente
Neuralgia do Pudendo/epidemiologia
Neuralgia do Pudendo/metabolismo
Neuralgia do Pudendo/fisiopatologia
Índice de Gravidade de Doença
Testosterona/análogos & derivados
Testosterona/sangue
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (5-alpha Reductase Inhibitors); 3XMK78S47O (Testosterone); 4G7DS2Q64Y (Progesterone); 57GNO57U7G (Finasteride); 73R90F7MQ8 (Pregnenolone)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170718
[Lr] Data última revisão:
170718
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170415
[St] Status:MEDLINE


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[PMID]:28339446
[Au] Autor:Petrov-Kondratov V; Chhabra A; Jones S
[Ad] Endereço:University of Texas Southwestern, Department of Anesthesiology, Dallas, TX.
[Ti] Título:Pulsed Radiofrequency Ablation of Pudendal Nerve for Treatment of a Case of Refractory Pelvic Pain.
[So] Source:Pain Physician;20(3):E451-E454, 2017 Mar.
[Is] ISSN:2150-1149
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Pudendal neuralgia (PN) is a result of pudendal nerve entrapment or injury, also called "Alcock syndrome." Pain that develops is often chronic, and at times debilitating. If conservative measures fail, invasive treatment modalities can be considered. The goal of this case report is to add to a small body of literature that a pulsed radiofrequency (PRF) ablation can be effectively used to treat PN and to show that high resolution MR neurography imaging can be used to detect pudendal neuropathy. CASE PRESENTATION: We present a case of a 51-year-old woman with 5 years of worsening right groin and vulva pain. Various medication trials only lead to limited improvement in pain. The first diagnostic right pudendal nerve block was done using 3 mL of 0.25% bupivacaine with 6mg of betamethasone using a transgluteal technique and a target of the right ischial spine; this procedure resulted in ~8 hours of > 50% pain relief. The patient was then referred for MR neurography of the lumbosacral plexus. This study revealed increased signal of the right pudendal nerve at the ischial spine and in the pudendal canal, findings consistent with the clinical picture of PN. Six weeks after the initial block, the patient underwent a second right transgluteal pudendal nerve block, utilizing 3 mL of 0.25% bupivacaine with 40 mg of triamcinolone acetonide; this procedure resulted in ~8 hours of 100% pain relief. Satisfied with these results the patient decided to undergo pudendal nerve PRF ablation for possible long-term relief. For this therapeutic procedure, a right transgluteal approach was again utilized. PRF ablation was performed for 240 seconds at 42° Celsius. Following this ablation the patient reported at least 6 weeks of significant (> 50%) pain relief. DISCUSSION AND CONCLUSION: In this paper we presented a case of successful treatment of PN with PRF ablation and detection of pudendal neuropathy on MR neurography. We believe that transgluteal PRF ablation for PN might be an effective, minimally invasive option for those patients that have failed conservative management. MR neurography employed in this case is not only helpful in confirming the diagnosis of PN but could also be useful in ruling out other causes of pelvic pain, such as genitofemoral neuropathy, endometriosis, adenomyosis, or pelvic mass lesion. To conclude, transgluteal PRF ablation can serve as a viable treatment option for mitigating symptoms of pudendal neuropathy and MR neurography is useful in confirming a clinically suspected diagnosis of PN.Key words: Pelvic pain, pudendal neuralgia, MR neurography, pulsed radiofrequency ablation, transgluteal technique, Alcock canal syndrome.
[Mh] Termos MeSH primário: Dor Intratável/cirurgia
Dor Pélvica/cirurgia
Nervo Pudendo/cirurgia
Neuralgia do Pudendo/cirurgia
Tratamento por Radiofrequência Pulsada
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Meia-Idade
Manejo da Dor/métodos
Dor Pélvica/etiologia
Pelve
Nervo Pudendo/fisiopatologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170325
[St] Status:MEDLINE


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[PMID]:28072805
[Au] Autor:Ploteau S; Perrouin-Verbe MA; Labat JJ; Riant T; Levesque A; Robert R
[Ad] Endereço:Federative Pelvic Pain Center, Nantes, France; Department of Gynecology-Obstetrics and Reproductive Medicine, Centre Hospitalier Universitaire, Nantes, France.
[Ti] Título:Anatomical Variants of the Pudendal Nerve Observed during a Transgluteal Surgical Approach in a Population of Patients with Pudendal Neuralgia.
[So] Source:Pain Physician;20(1):E137-E143, 2017 Jan-Feb.
[Is] ISSN:2150-1149
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Several studies have described the course and anatomical relations of the pudendal nerve. Several surgical nerve decompression techniques have been described, but only the transgluteal approach has been validated by a prospective randomized clinical trial. The purpose of this study was to describe the course of the nerve and its variants in a population of patients with pudendal neuralgia in order to guide the surgeon in the choice of surgical approach for pudendal nerve decompression. OBJECTIVES: In order to support the choice of the transgluteal approach, used in our institution, we studied the exact topography, anatomical relations, and zones of entrapment of the pudendal nerve in a cohort of operated patients. STUDY DESIGN: Observational study. SETTING: University hospital. METHODS: One hundred patients underwent unilateral or bilateral nerve decompression performed by a single operator via a transgluteal approach. All patients satisfied the Nantes criteria for pudendal neuralgia. The operator meticulously recorded zones of entrapment, anatomical variants of the course of the nerve, and the appearance of the nerve in the operative report. RESULTS: One hundred patients and 145 nerves were operated consecutively. Compression of at least one segment of the pudendal nerve (infrapiriform foramen, ischial spine, and Alcock's canal) was observed in 95 patients. The zone of entrapment was situated at the ischial spine between the sacrospinous ligament (or ischial spine) and the sacrotuberous ligament in 74% of patients.Anatomical variants were observed in 13 patients and 15 nerves. Seven patients presented an abnormal transligamentous course of the nerve (sacrotuberous or sacrospinous). A perineal branch of the fourth sacral nerve to the external anal sphincter was identified in 7 patients. In this population of patients with pudendal neuralgia, the pudendal nerve was stenotic in 27% of cases, associated with an extensive venous plexus that could make surgery more difficult in 25% of cases, and the nerve had an inflammatory appearance in 24% of cases. LIMITATIONS: We obviously cannot be sure that the anatomical variants identified in this study can be extrapolated to the general population, as our study population was composed of patients experiencing perineal pain due to pudendal nerve entrapment and their pain could possibly be related to these anatomical variants, especially a transligamentous course of the pudendal nerve. The absence of other prospective randomized clinical trials evaluating other surgical approaches also prevents comparison of these results with those of other surgical approaches. CONCLUSIONS: This is the first study to describe the surgical anatomy of the pudendal nerve in a population of patients with pudendal neuralgia. In more than 70% of cases, pudendal nerve entrapment was situated in the space between the sacrospinous ligament and the sacrotuberous ligament. Anatomical variants of the pudendal nerve were also observed in 13% of patients, sometimes with a transligamentous course of the nerve. In the light of these results, we believe that a transgluteal approach is the most suitable surgical approach for safe pudendal nerve decompression by allowing constant visual control of the nerve.Key words: Surgical, operative technique, pudendal, neuralgia, transgluteal approach.
[Mh] Termos MeSH primário: Nervo Pudendo/patologia
Neuralgia do Pudendo
[Mh] Termos MeSH secundário: Seres Humanos
Síndromes de Compressão Nervosa/cirurgia
Neuralgia
Dor Pélvica/patologia
Dor Pélvica/cirurgia
Estudos Prospectivos
Neuralgia do Pudendo/patologia
Neuralgia do Pudendo/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170721
[Lr] Data última revisão:
170721
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170111
[St] Status:MEDLINE


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[PMID]:27539957
[Au] Autor:Tsai K; Singh D; Pinkhasov A
[Ad] Endereço:Stony Brook University School of Medicine and Department of Behavioral Health, Winthrop University Hospital, Stony Brook, New York.
[Ti] Título:Pudendal nerve entrapment leading to avoidant/restrictive food intake disorder (ARFID): A case report.
[So] Source:Int J Eat Disord;50(1):84-87, 2017 Jan.
[Is] ISSN:1098-108X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Avoidant/restrictive food intake disorder (ARFID) is a diagnosis in diagnostic and statistical manual of mental disorders-5 (DSM-5) manifested by persistent failure to meet nutritional and/or energy needs. Pudendal nerve entrapment (PNE) often causes pelvic discomfort in addition to constipation and painful bowel movements. Current literature on ARFID is sparse and focuses on the pediatric and adolescent population. No association between PNE and ARFID has been described. We present a case of ARFID in an adult male with PNE resulting from subsequent scarring from testicular cancer surgery. The patient's gastrointestinal symptoms due to PNE caused significant food avoidance and restriction subsequently leading to severe malnourishment. Clinicians should be aware that distressing gastrointestinal symptoms arising from a secondary disease process such as PNE might lead to dietary restriction and food aversion. More research is needed for proper screening, detection, and treatment of ARFID. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:84-87).
[Mh] Termos MeSH primário: Transtornos da Alimentação e da Ingestão de Alimentos/etiologia
Complicações Pós-Operatórias
Neuralgia do Pudendo/complicações
[Mh] Termos MeSH secundário: Caquexia/etiologia
Constipação Intestinal/etiologia
Seres Humanos
Masculino
Meia-Idade
Neuralgia do Pudendo/psicologia
Neoplasias Testiculares/complicações
Neoplasias Testiculares/cirurgia
[Pt] Tipo de publicação:CASE REPORTS
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170630
[Lr] Data última revisão:
170630
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160820
[St] Status:MEDLINE
[do] DOI:10.1002/eat.22601


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[PMID]:27626835
[Au] Autor:Leone JE; Middleton S
[Ad] Endereço:Bridgewater State University, MA.
[Ti] Título:Nontraumatic Testicular Pain due to Sacroiliac-Joint Dysfunction: A Case Report.
[So] Source:J Athl Train;51(8):651-657, 2016 Aug.
[Is] ISSN:1938-162X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To discuss the case of a 49-year-old man who presented to the sports medicine staff with pelvic pain of 10 years' duration consistent with pudendal neuralgia. BACKGROUND: Testicular pain in men is often provoked by direct trauma or may indicate an oncologic process. DIFFERENTIAL DIAGNOSIS: Epididymitis, athletic pubalgia, testicular tumor, sacroiliac joint dysfunction, lumbar radiculopathy. TREATMENT: The patient responded positively to treatment and rehabilitation to restore normal mechanics to the lumbo-pelvic-hip complex. Several flare-ups since the initial treatment have been of short duration (<2 days) and less intense. UNIQUENESS: Pudendal neuralgia tends to affect females more than males due to changes in the alignment and stability of the pelvis from a combination of a shorter, wider pelvis and muscle imbalances associated with childbirth. Typically, males with testicular pain suffer from epididymitis or some type of testicular torsion, which was not the situation in this case. Compression is also a common cause of pudendal neuralgia, although it was not responsible for this patient's pain, making diagnosis and treatment complex. CONCLUSIONS: Many pain syndromes can be treated with removal of the original stimulus. However, recognizing the factors contributing to pelvic pain and dysfunction in males can be a challenge for the sports medicine professional. A vigilant and unassuming approach to male pelvic pain is warranted, particularly by health care providers in diverse practice settings.
[Mh] Termos MeSH primário: Neuralgia do Pudendo/etiologia
Articulação Sacroilíaca/fisiopatologia
Testículo
[Mh] Termos MeSH secundário: Diagnóstico Diferencial
Seres Humanos
Masculino
Meia-Idade
Dor Pélvica/etiologia
Neuralgia do Pudendo/diagnóstico
Neuralgia do Pudendo/terapia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170801
[Lr] Data última revisão:
170801
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160915
[St] Status:MEDLINE


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[PMID]:27284095
[Au] Autor:Armstrong GL; Vancaillie TG
[Ad] Endereço:Department of Obstetrics and Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
[Ti] Título:Combined site-specific sacral neuromodulation and pudendal nerve release surgery in a patient with interstitial cystitis and persistent arousal.
[So] Source:BMJ Case Rep;2016, 2016 Jun 09.
[Is] ISSN:1757-790X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:A variety of neuromodulation approaches have been described for the management of pelvic neuropathies, including interstitial cystitis, pudendal neuralgia and persistent genital arousal disorder. The benefits of a combined sacral and pudendal nerve neuromodulator has yet to be explored for these patients. In this report, we describe the case of a 35-year-old woman with a complex pelvic neuropathy resulting in urinary, sexual and gastro-intestinal dysfunction. She presented with an established diagnosis of interstitial cystitis; however, she also fulfilled diagnostic criteria for pudendal neuralgia and persistent genital arousal disorder. The patient underwent implantation of a combined sacral and pudendal nerve neuoromodulation device at the time of surgical decompression of the pudendal nerves. An impressive clinical response followed. This case demonstrates a unique clinical presentation and highlights the value of a combined surgical and neuromodulatory approach in the management of patients with complex pelvic neuropathies.
[Mh] Termos MeSH primário: Cistite Intersticial/terapia
Terapia por Estimulação Elétrica
Neuroestimuladores Implantáveis
Neuralgia do Pudendo/terapia
Disfunções Sexuais Psicogênicas/terapia
[Mh] Termos MeSH secundário: Adulto
Terapia Combinada
Cistite Intersticial/cirurgia
Descompressão Cirúrgica
Feminino
Seres Humanos
Neuralgia do Pudendo/cirurgia
Disfunções Sexuais Psicogênicas/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170224
[Lr] Data última revisão:
170224
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160611
[St] Status:MEDLINE


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[PMID]:27228517
[Au] Autor:Antolak S; Antolak C; Lendway L
[Ad] Endereço:Center for Urologic and Pelvic Pain; St. Paul, MN.
[Ti] Título:Measuring the Quality of Pudendal Nerve Perineural Injections.
[So] Source:Pain Physician;19(4):299-306, 2016 05.
[Is] ISSN:2150-1149
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Pudendal neuropathy is a tunnel syndrome characterized by pelvic pain and may include bowel, bladder, or sexual dysfunction or a combination of these. One treatment method, pudendal nerve perineural injections (PNPIs), uses infiltration of bupivacaine and corticosteroid around the nerve to provide symptom relief. Bupivacaine also anesthetizes the skin in the receptive field of the nerve that is injected. Bupivacaine offers rapid pain relief for several hours while corticosteroid provides delayed pain control often lasting 3 to 5 weeks. Not all pudendal nerve blocks may provide complete pain relief but long-term pain control from the steroid appears to be associated with immediate response to bupivacaine. We offer a method of evaluating the quality of a pudendal block on the day it is performed using pinprick sensation evaluation. OBJECTIVE: To demonstrate that pinprick sensory changes provide a simple and rapid method of measuring response to local anesthetic and pain reduction provided by a PNPI on the day it is performed. This response defines the quality of each PNPI. STUDY DESIGN: This is a case series based on retrospective review of a private practice database that is maintained by HealthEast hospitals in Minnesota. Database information includes standard physical examination, recording techniques, and treatment processes that had been in place for several years. SETTING: Private practice in United States. METHODS: Patients with a diagnosis of pudendal neuropathy are treated with PNPIs. Two hours after each block, 2 endpoints are measured: response to a sensory pinprick examination of the pudendal territory and difference in patient-reported pain level before and after nerve block. Fifty-three men from a private practice treating only pelvic pain received the treatment in 2005. Reported pain level was not recorded for 2 patients. RESULTS: Bupivacaine in perineural injections produces varying degrees of analgesia or hypalgesia to pinprick. Normal pinprick response suggests pudendal nerves were not penetrated by bupivacaine. Patient responses varied from complete, i.e. all 6 branches anesthetized to none. Most men had 2 - 5 nerve branches anesthetized. One man had a single nerve branch that responded to bupivacaine. Three men failed to respond to local anesthetic.Changes in pre-PNPI to post-PNPI pain scores were significantly decreased (n = 51, P-value < 0.0001), indicating that bupivacaine in the PNPI reduced pain. Forty-one patients (80.4%) indicated less pain after the procedure and only 2 patients (4.0%) indicated more pain. The number of nerve branches successfully anesthetized was also significantly correlated with change in score. On average, an additional successful nerve branch anesthetized corresponded to a drop of about 0.66 in the change score (n = 51, P - value = 0.0005). CONCLUSION: PNPIs relieve pain. Anesthesia affected all 6 pudendal nerve branches in only 13.2% of patients. Complete pain relief occurred in 39.2%. This argues against use of perineural pudendal blockade as a diagnostic test. Pain relief after PNPI is associated with number of nerve branches that are anesthetized. At 2 hours after a PNPI its quality (the number of the 6 nerve branches with reduced response to pinprick from the perineural local anesthetic) is associated with subjective reduction of pain. KEY WORDS: Pudendal neuralgia, chronic perineal pain, pudendal nerve block, sensory examination, neurologic examination, pain management, chronic pelvic pain syndrome.
[Mh] Termos MeSH primário: Anestésicos Locais/farmacologia
Bloqueio Nervoso Autônomo/métodos
Bupivacaína/farmacologia
Avaliação de Resultados (Cuidados de Saúde)
Dor Pélvica/tratamento farmacológico
Nervo Pudendo/efeitos dos fármacos
Neuralgia do Pudendo/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Anestésicos Locais/administração & dosagem
Bupivacaína/administração & dosagem
Seres Humanos
Injeções
Masculino
Dor Pélvica/etiologia
Neuralgia do Pudendo/complicações
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anesthetics, Local); Y8335394RO (Bupivacaine)
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170213
[Lr] Data última revisão:
170213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160527
[St] Status:MEDLINE


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[PMID]:27008300
[Au] Autor:Ploteau S; Cardaillac C; Perrouin-Verbe MA; Riant T; Labat JJ
[Ad] Endereço:Federative Pelvic Pain Center, Nantes, France.
[Ti] Título:Pudendal Neuralgia Due to Pudendal Nerve Entrapment: Warning Signs Observed in Two Cases and Review of the Literature.
[So] Source:Pain Physician;19(3):E449-54, 2016 Mar.
[Is] ISSN:2150-1149
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Pudendal neuralgia is a chronic neuropathic pelvic pain that is often misdiagnosed and inappropriately treated. The Nantes criteria provide a basis for the diagnosis of pudendal neuralgia due to pudendal nerve entrapment. The 5 essential diagnostic criteria are pain situated in the anatomical territory of the pudendal nerve, worsened by sitting, the patient is not woken at night by the pain, and no objective sensory loss is detected on clinical examination. The fifth criterion is a positive pudendal nerve block. We have also clarified a number of complementary diagnostic criteria and several exclusion criteria that make the diagnosis unlikely. When pudendal neuralgia due to pudendal nerve entrapment is diagnosed according to the Nantes criteria, no further investigation is required and medical or surgical treatment can be proposed. Nevertheless, a number of warning signs suggesting other possible causes of pudendal neuralgia must not be overlooked. These warning signs (red flags) are waking up at night, excessively neuropathic nature of the pain (for example, associated with hypoesthesia), specifically pinpointed pain, which can suggest neuroma and pain associated with neurological deficit. In these atypical presentations, the diagnosis of pain due to pudendal nerve entrapment should be reconsidered and a radiological examination should be performed. The 2 cases described in this report (tumor compression of the pudendal nerve) illustrate the need to recognize atypical pudendal neuralgia and clarify the role of pelvic magnetic resonance imaging (MRI), as MRI provides very valuable information for the evaluation of diseases involving the ischiorectal fossa. The presence of red flags must be investigated in all cases of pudendal neuralgia to avoid missing pudendal neuralgia secondary to a mechanism other than nerve entrapment.
[Mh] Termos MeSH primário: Síndromes de Compressão Nervosa/complicações
Nervo Pudendo/patologia
Neuralgia do Pudendo/etiologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Imagem por Ressonância Magnética
Bloqueio Nervoso
Síndromes de Compressão Nervosa/diagnóstico
Neuralgia/patologia
Medição da Dor
Neoplasias Pélvicas/complicações
Neoplasias Pélvicas/patologia
Dor Pélvica/etiologia
Dor Pélvica/patologia
Neuralgia do Pudendo/diagnóstico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1611
[Cu] Atualização por classe:161230
[Lr] Data última revisão:
161230
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160324
[St] Status:MEDLINE


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[PMID]:26699147
[Au] Autor:Hong MJ; Kim YD; Park JK; Hong HJ
[Ad] Endereço:Department of Rheumatology, Presbyterian Medical Center, Jeonju, Republic of Korea.
[Ti] Título:Management of pudendal neuralgia using ultrasound-guided pulsed radiofrequency: a report of two cases and discussion of pudendal nerve block techniques.
[So] Source:J Anesth;30(2):356-9, 2016 Apr.
[Is] ISSN:1438-8359
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:Pudendal neuralgia is characterized by chronic pain or discomfort in the area innervated by the pudendal nerve, with no obvious cause. A successful pudendal nerve block is crucial for the diagnosis of pudendal neuralgia. Blind or fluoroscopy-guided pudendal nerve blocks have been conventionally used for diagnosis and treatment; however, ultrasound-guided pudendal nerve blocks were also reported recently. With regard to the achievement of long-term effects, although pulsed radiofrequency performed under fluoroscopic guidance has been reported, that performed under ultrasound guidance is not well reported. This report describes two cases of pudendal neuralgia that were successfully managed using ultrasound-guided pulsed radiofrequency and presents a literature review of pudendal nerve block techniques. However, in the management of chronic neuropathic pain, physicians should keep in mind that the placebo effect related to invasive approaches must not be neglected.
[Mh] Termos MeSH primário: Bloqueio Nervoso/métodos
Neuralgia do Pudendo/terapia
Tratamento por Radiofrequência Pulsada/métodos
[Mh] Termos MeSH secundário: Feminino
Fluoroscopia
Seres Humanos
Meia-Idade
Neuralgia/terapia
Nervo Pudendo
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1611
[Cu] Atualização por classe:171011
[Lr] Data última revisão:
171011
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151225
[St] Status:MEDLINE
[do] DOI:10.1007/s00540-015-2121-x


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[PMID]:26663728
[Au] Autor:Peters KM; Killinger KA; Jaeger C; Chen C
[Ad] Endereço:Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
[Ti] Título:Pilot Study Exploring Chronic Pudendal Neuromodulation as a Treatment Option for Pain Associated with Pudendal Neuralgia.
[So] Source:Low Urin Tract Symptoms;7(3):138-42, 2015 Sep.
[Is] ISSN:1757-5672
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Pudendal neuralgia can cause significant voiding and pain symptoms. We explored the effects of chronic pudendal neuromodulation (CPN) and nerve blocks on pain associated with pudendal neuralgia. METHODS: Patients with pudendal neuralgia and tined lead placed at the pudendal nerve were reviewed. History and initial improvement after lead placement were collected from medical records. Demographics, symptom characteristics and changes after various treatments were assessed by mailed survey. Descriptive statistics were performed. RESULTS: Of 19 patients (mean age 54.8 years, 63% female), 6/19 (32%) had previous sacral neuromodulation. Before CPN, 18 patients had 77 nerve blocks (median six blocks per patient); most blocks (60/77; 78%) provided at least some relief. After lead placement, pain relief was complete in three patients, almost complete in three, significant/remarkable in 10, and small/slight in three. All 19 patients had a permanent generator placed. Five were ultimately explanted at (mean) 2.95 years: one had total symptom resolution, one had stopped using the device, and three lost efficacy. Survey respondents (n = 10) indicated that they had been experiencing pain for (median) 4.42 years before CPN. The most helpful pain treatment cited was medication for 6/10 and neuromodulation for 4/10; 8/9 rated neuromodulation as more helpful than nerve block, while one subject felt that the two treatments were equally helpful. Compared to sacral neuromodulation, 3/4 rated CPN as more effective for pain. Overall, 8/10 were satisfied with CPN; only 1/9 was mildly satisfied with nerve block. CONCLUSIONS: Chronic pudendal neuromodulation can improve pain in patients with pudendal neuralgia.
[Mh] Termos MeSH primário: Analgesia/métodos
Terapia por Estimulação Elétrica
Neuralgia do Pudendo/terapia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Terapia por Estimulação Elétrica/métodos
Feminino
Seres Humanos
Masculino
Meia-Idade
Projetos Piloto
Nervo Pudendo
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1609
[Cu] Atualização por classe:151215
[Lr] Data última revisão:
151215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151215
[St] Status:MEDLINE
[do] DOI:10.1111/luts.12066



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