Pudendal neuralgia and imaging methods

Česká verze

Authors: Tereza Duchoňová ¹; Tomáš Fučík ²; Jan Dvořák ²; Jaroslav Tintěra ³; Dana Kautznerová ³ ; Kamil Švabík ² ; Jaromír Mašata ²
Published in the journal: Ceska Gynekol 2024; 89(6): 496-500
Category: Přehledová práce
doi: https://doi.org/10.48095/cccg2024496

Summary

Objective: To create a comprehensive overview of imaging methods for diagnosing pudendal neuralgia. Methodology: Literature review. Conclusion: Pudendal neuralgia is a chronic pain condition that is difficult to diagnose. On average, it takes 5 years from the onset of symptoms to the correct diagnosis. Diagnosis is based on symptoms described by the patient, neuropelveological physical examination, and presence of the 5 Nantes criteria. Imaging methods, especially ultrasound and magnetic resonance imaging of the pudendal nerve, show great promise for a more accurate and faster diagnosis. These methods can assist in diagnosing issues and excluding other pathologies that may cause symptoms.

Keywords:

magnetic resonance – imaging methods – chronic pelvic pain – pudendal neuralgia – pudendal nerve

Zdroje

1. Hibner M, Desai N, Robertson LJ et al. Pudendal neuralgia. J Minim Invasive Gynecol 2010; 17 (2): 148–153. doi: 10.1016/j.jmig.2009.11.003.

2. Robert R, Prat-Pradal D, Labat JJ et al. Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surg Radiol Anat 1998; 20 (2): 93–98. doi: 10.1007/BF01628908.

3. Calabrò RS, Gervasi G, Marino S et al. Misdiagnosed chronic pelvic pain: pudendal neuralgia responding to a novel use of palmitoylethanolamide. Pain Med 2010; 11 (5): 781–784. doi: 10.1111/j.1526-4637.2010.00823.x.

4. Labat JJ, Riant T, Robert R et al. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn 2008; 27 (4): 306–310. doi: 10.1002/nau.20505.

5. Waldinger MD, Venema PL, van Gils AP et al. New insights into restless genital syndrome: static mechanical hyperesthesia and neuropathy of the nervus dorsalis clitoridis. J Sex Med 2009; 6 (10): 2778–2787. doi: 10.1111/j.1743-6109.2009.01435.x

6. Pérez-López FR, Hita-Contreras F. Management of pudendal neuralgia. Climacteric 2014; 17 (6): 654–656. doi: 10.3109/13697137.2014.912263.

7. Fanucci E, Manenti G, Ursone A et al. Role of interventional radiology in pudendal neuralgia: a description of techniques and review of the literature. Radiol Med 2009; 114 (3): 425–436. doi: 10.1007/s11547-009-0371-0.

8. Furtmüller GJ, McKenna CA, Ebmer J et al. Pudendal nerve 3-dimensional illustration gives insight into surgical approaches. Ann Plast Surg 2014; 73 (6): 670–678. doi: 10.1097/SAP.0000000000000169.

9. Lemos N, Possover M. Laparoscopic approach to intrapelvic nerve entrapments. J Hip Preserv Surg 2015; 2 (2): 92–98. doi: 10.1093/jhps/hnv030.

10. Wadhwa V, Hamid AS, Kumar Y et al. Pudendal nerve and branch neuropathy: magnetic resonance neurography evaluation. Acta Radiol 2017; 58 (6): 726–733. doi: 10.1177/0284185116668213.

11. Hong MJ, Kim YD, Park JK et al. Management of pudendal neuralgia using ultrasound-guided pulsed radiofrequency: a report of two cases and discussion of pudendal nerve block techniques. J Anesth 2016; 30 (2): 356–359. doi: 10.1007/s00540-015-2121-x.

12. Fučík T, Mašata J. Pánevní neuropatická bolest (diferenciální diagnostika). Ceska Gynekol 2021; 86 (4): 279–283. doi: 10.48095/cccg2021279.

13. Filler AG. Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery. Neurosurg Focus 2009; 26 (2): E9. doi: 10.3171/FOC.2009.26.2.E9.

14. Mahakkanukrauh P, Surin P, Vaidhayakarn P. Anatomical study of the pudendal nerve adjacent to the sacrospinous ligament. Clin Anat 2005; 18 (3): 200–205. doi: 10.1002/ca.20084.

15. Martinoli C, Miguel-Perez M, Padua L et al. Imaging of neuropathies about the hip. Eur J Radiol 2013; 82 (1): 17–26. doi: 10.1016/j.ejrad.2011.04.034.

16. Soldatos T, Andreisek G, Thawait GK et al. High--resolution 3-T MR neurography of the lumbosacral plexus. Radiographics 2013; 33 (4): 967–987. doi: 10.1148/rg.334115761.

17. Chhabra A, McKenna CA, Wadhwa V et al. 3T magnetic resonance neurography of pudendal nerve with cadaveric dissection correlation. World J Radiol 2016; 8 (7): 700–706. doi: 10.4329/wjr.v8.i7.700.

18. Lemos N, Melo HJ, Sermer C et al. Lumbosacral plexus MR tractography: a novel diagnostic tool for extraspinal sciatica and pudendal neuralgia? Magn Reson Imaging 2021; 83 : 107–113. doi: 10.1016/j.mri.2021.08.003.

19. Burdan F, Mocarska A, Janczarek M et al. Incidence of spinal perineurial (Tarlov) cysts among East-European patients. PLoS One 2013; 8 (8): e71514. doi: 10.1371/journal.pone.0071514.

20. Kuhn FP, Hammoud S, Lefèvre-Colau MM et al. Prevalence of simple and complex sacral perineural Tarlov cysts in a French cohort of adults and children. J Neuroradiol 2017; 44 (1): 38–43. doi: 10.1016/j.neurad.2016.09.006.

21. Langdown AJ, Grundy JR, Birch NC. The clinical relevance of Tarlov cysts. J Spinal Disord Tech 2005; 18 (1): 29–33. doi: 10.1097/01.bsd.0000133495.78245.71.

22. Lim VM, Khanna R, Kalinkin O et al. Evaluating the discordant relationship between Tarlov cysts and symptoms of pudendal neuralgia. Am J Obstet Gynecol 2020; 222 (1): 70.e1–70.e6. doi: 10.1016/j.ajog.2019.07.021.

23. Park HJ, Jeon YH, Rho MH et al. Incidental findings of the lumbar spine at MRI during herniated intervertebral disk disease evaluation. AJR Am J Roentgenol 2011; 196 (5): 1151–1155. doi: 10.2214/AJR.10.5457.

24. Paulsen RD, Call GA, Murtagh FR. Prevalence and percutaneous drainage of cysts of the sacral nerve root sheath (Tarlov cysts). AJNR Am J Neuroradiol 1994; 15 (2): 293–299.

25. Holý M. Syndrom pánevní kongesce. Kardiol Rev Int Med 2014; 16 (4): 321–329.

26. Koo S, Fan CM. Pelvic congestion syndrome and pelvic varicosities. Tech Vasc Interv Radiol 2014; 17 (2): 90–95. doi: 10.1053/j.tvir.2014.02.005.

27. Tagliafico A, Bignotti B, Miguel Perez M et al. Contribution of ultrasound in the assessment of patients with suspect idiopathic pudendal nerve disease. Clin Neurophysiol 2014; 125 (6): 1278–1284. doi: 10.1016/j.clinph.2013.10.053.

28. Tagliafico A, Perez MM, Martinoli C. High-resolution ultrasound of the pudendal nerve: normal anatomy. Muscle Nerve 2013; 47 (3): 403–408. doi: 10.1002/mus.23537.

29. Dvorak J, Svabik K, Masata J. An atypical case of dyspareunia in a 27-year-old patient. Int Urogynecol J 2022; 33 (1): 157–158. doi: 10.1007/s00192-021-04943-3.

30. Dvorak J, Svabík K, Masata J. Pain following injection of urethral elastomer bulking agent. Int Urogynecol J 2023; 34 (2): 597–599. doi: 10.1007/s00192-022-05314-2.

31. Hubka P, Nanka O, Martan A et al. Anatomical study of position of the TVT-O to the obturator nerve influenced by the position of the legs during the procedure: based upon findings at formalin-embalmed and fresh-frozen bodies. Arch Gynecol Obstet 2011; 284 (4): 901–905. doi: 10.1007/s00404-010-1775-8.

32. Masata J, Hubka P, Martan A. Pudendal neuralgia following transobturator inside-out tape procedure (TVT-O) -case report and anatomical study. Int Urogynecol J 2012; 23 (4): 505–507. doi: 10.1007/s00192-011-1555-4.

ORCID autorů

K. Švabík 0000-0003-1778-2101

J. Mašata 0000-0002-3898-6608

Doručeno/Submitted: 11. 9. 2024

Přijato/Accepted: 10. 10. 2024

MUDr. Tereza Duchoňová

Gynekologicko-porodnická klinika

Nemocnice Quiron Salud Malaga

Av. Imperio Argentina, 1

Carretera de Cádiz

29004 Malaga

Španělsko