E-Posters-10178_Papillon

10178_Papillon_Smith

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This document is a review of 50 consecutive cases of refractory pudendal pain and pelvic floor dysfunction caused by intrapelvic nerve entrapment. The study was conducted by the Department of Obstetrics and Gynecology at Mount Sinai Hospital in Toronto, Canada, and the Department of Obstetrics and Gynecology at Escola Paulista de Medicina in Sao Paulo, Brazil.<br /><br />The most common causes of nerve entrapment were vascular entrapment by varicose veins and endometriosis. The most commonly involved nerves were the right S2, S3, and S4 sacral nerve roots.<br /><br />The study used visual analogue scale (VAS) scores to assess pain severity at each visit. The preoperative VAS scores were compared to the VAS scores at the last postoperative visit using paired t-tests. A 50% reduction in VAS scores and/or a significant reduction in the use of analgesics was considered a successful outcome.<br /><br />The results showed that 86.3% of patients reported at least a 50% improvement in pain scores. The median of one previous ineffective surgery for symptom treatment was reported, and the average interval between symptom onset and correct diagnosis was 4.48 years.<br /><br />Approaching the intrapelvic portions of the lumbosacral nerve roots surgically remains a challenge. Laparotomy and transgluteal routes are difficult, while laparoscopy (LSC) may be the best approach. Intrapelvic nerve entrapment is a neglected cause of perineal and sciatic pain, and awareness must be raised among physicians to provide timely diagnosis and avoid unnecessary or ineffective surgical procedures.<br /><br />The diagnosis and treatment of intrapelvic nerve entrapment are poorly understood, and physicians should be more aware of this condition. Approaching the lumbosacral plexus laparoscopically for nerve entrapment treatment produces satisfactory and reproducible results.

Keywords

refractory pudendal pain

pelvic floor dysfunction

intrapelvic nerve entrapment

vascular entrapment

varicose veins

endometriosis

S2 sacral nerve root

S3 sacral nerve root

S4 sacral nerve root

visual analogue scale