Endoscopic transperineal pudendal nerve decompression: operative pudendoscopy

Area of Science:

• Urology
• Neurology
• Surgical Innovation

Background:

• Pudendal nerve entrapment causes pudendal syndrome, characterized by perineodynia and functional deficits in urinary, sexual, and anorectal systems.
• Surgical intervention, particularly the transperineal approach, is a recognized treatment modality for this condition.

Purpose of the Study:

• To detail the technical aspects of operative pudendoscopy, a minimally invasive technique utilizing an endoscope for pudendal nerve decompression.
• To evaluate the clinical outcomes of operative pudendoscopy in patients suffering from severe pudendal syndrome.

Main Methods:

• Operative pudendoscopy was performed on 113 patients with severe pudendal syndrome.
• Pre- and post-operative assessments included pain visual analog scale (VAS) for perineodynia and validated symptom scores (ICIQ-SF, NHI-CPSI, St Mark's, Wexner).
• Clinical signs of pudendal syndrome and perineal descent were analyzed in 91 patients before and after surgery.

Main Results:

• Surgery resulted in a significant reduction in perineodynia VAS (from 7.2 to 4.5, p < 0.0001) and improvement in all assessed symptom scores.
• Significant improvements were noted in sexual arousal syndrome, dyspareunia, and cystalgia.
• Pathological perineal descent was significantly reduced post-operatively (from 1.81 cm to 0.77 cm, p < 0.0001).

Conclusions:

• Operative pudendoscopy allows for safe, visually controlled, and complete decompression of the pudendal nerve from its distal branches to the sacral foramina.
• This technique significantly improves the clinical signs and symptoms associated with pudendal syndrome.
• The study highlights operative pudendoscopy as an effective treatment for pudendal syndrome.