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Unilateral pudendal neuropathy. Significance and implications
Y P Sangwan1, J A Coller, M S Barrett
1Department of Colon and Rectal Surgery, Lahey Hitchcock Medical Center, Burlington, Massachusetts, 01805 USA.
Diseases of the Colon and Rectum
|March 1, 1996
Summary
Many patients with pelvic floor issues experience unilateral pudendal neuropathy, even with normal mean nerve latency. This finding is crucial for surgical planning and prognosis in sphincter injury cases.
Area of Science:
- Neurology
- Gastroenterology
- Urogynecology
Background:
- Pudendal neuropathy, often linked to obstetric trauma and straining, can cause pelvic floor dysfunction.
- Bilateral increase in pudendal nerve terminal motor latencies (PNTML) is typically associated with this condition.
- However, unilateral PNTML prolongation is frequently observed, necessitating further investigation.
Purpose of the Study:
- To investigate the diagnostic and therapeutic implications of unilateral pudendal neuropathy.
- To determine the prevalence and significance of unilateral PNTML prolongation in patients with pelvic floor disorders.
Main Methods:
- Review of 174 patients undergoing anorectal manometry and PNTML testing.
- PNTML determination using a pudendal (St. Mark's) electrode and dynamic pressure analysis.
- Analysis of bilateral and unilateral PNTML results.
Main Results:
- PNTML determination was possible in 136 patients (78%).
- Of these, 53 patients (39%) showed delayed conduction: 15 (28%) bilaterally and 38 (72%) unilaterally.
- Unilateral PNTML prolongation was observed in 38 patients, with varying mean PNTML values.
Conclusions:
- A significant proportion of patients with pelvic floor disorders present with unilateral pudendal neuropathy.
- Unilateral PNTML prolongation indicates pudendal neuropathy, irrespective of the mean PNTML value.
- Recognizing unilateral neuropathy is vital for surgical planning and predicting outcomes in sphincter injury patients.