Pudendal nerve branch injury during radical perineal prostatectomy

Sciatic Nerve to Pudendal Nerve Transfer: Anatomical Feasibility for a New Proposed Technique

Aim Restoration of bladder and bowel continence after pudendal nerve anastomosis has been shown successfully in animal models and may be applicable in humans. Aim of this cadaveric study was to assess feasibility of pudendal nerve neurotization using motor fascicles from sciatic nerve.

Methods Pudendal and sciatic nerves were exposed via gluteal approach in 5 human cadavers (10 sites). Size of pudendal and sciatic nerves and the distance between two nerves was measured.

Results There were four male and one female cadavers. Mean age was 62 (range, 50–70) years. Mean pudendal nerve diameter was 2.94 mm (right side) and 2.82 mm (left side). Mean sciatic nerve diameter was 11.2 mm (right side) and 14.2 mm (left side). The distance between two nerves was 23.4 mm on both sides.

Conclusion Transfer of the motor fascicles from sciatic nerve to pudendal nerve to restore the bladder and bowel continence is feasible.

Injury to the perineal branch of the pudendal nerve in men: Outcomes from surgical resection of the perineal branches

OBJECTIVE

The objective is to report the outcome of an anterior surgical approach to treat neuroma of the perineal branch of the pudendal nerve (PBPN).

PATIENTS AND METHODS

An IRB-approved prospective study enrolled 14 consecutive male patients from 2011 through 2015 who had symptoms of perineal/scrotal pain. Each patient had a successful, diagnostic, pudendal nerve block. The surgical procedure was resection of the PBPN and implantation of the nerve into the obturator internus muscle. Mean age at surgery was 50 ± 15 years. Median duration of pain symptoms was 5.5 years (range 1.2-42.9 years). Mechanisms of injury was exercise (6/14), prostatectomy (4/14), and falls (4/14). Outcomes were the Male Pudendal Pain Functional Questionnaire (MQ), and the Numeric Pain Rating Scale (NPRS).

RESULTS

The mean postoperative follow-up was 26 ± 14 months. The MQ demonstrated that after surgery, patients overall had significantly less disability due to pudendal pain (P < .03). The NPRS revealed that pain significantly improved (P < .004).

CONCLUSIONS

Resection of the PBPN and implantation of this nerve into the obturator internus muscle significantly relieved men's pelvic pain disability.

[Management of chronic postoperative pelvic and perineal pain due to parietal somatic nerve damage]

INTRODUCTION

All surgical procedures require an incision with a risk of nerve damage at the site of the scar or as a result of fibrotic scar tissue. The purpose of this article is to describe the management of chronic postoperative pelvic and perineal pain due to parietal somatic nerve damage.

PATIENTS AND METHODS

A comprehensive review of the literature was performed by searching PUBMED for articles on the management of chronic postoperative pelvic and perineal pain due to parietal somatic nerve damage.

RESULTS

Postoperative lesions of parietal somatic nerves (ilioinguinal, iliohypogastric, genitofemoral, pudendal, obturator, femoral) are frequent after pelvic surgery. Clinical examination of the scars (trigger zone) and detailed analysis of the topography and type of pain are essential elements in the analysis of this pain. Infiltration of local anaesthetic at the trigger point or along the nerve has a diagnostic value. Corticosteroid infiltrations and minimally invasive treatments such as pulsed radiofrequency have provided more or less lasting improvement of the symptoms. Surgical nerve release together with resection of fibrosis and removal of prosthetic material provides good long-term results. The surgical approach depends on the nerve concerned and the level of the lesion.

CONCLUSION

The management of chronic postoperative pelvic and perineal pain due to parietal somatic nerve damage is based on local infiltration of anaesthetics and corticosteroids. Nerve release surgery with resection of fibrosis provides the best long-term results.