Life Quality After Decompression of the Pudendal Nerve – Is Surgery a Viable Option?

Christliches Krankenhaus, Quakenbrück, Germany

Rahmanowa J, Dömer P, Augenstein H-J, Kretschmer T

INTRODUCTION: Pudendal neuralgia can be caused by a rare nerve compression. Affected patients suffer severe impairment of their social and personal life. Surgical decompression of the nerve is a treatment option. We evaluated patients’ satisfaction after surgery. Material and methods: Retrospectively, we analyzed patient data and patients’ satisfaction using an adapted questionnaire.

RESULTS: From 2015-2023 n=33 patients were operated on for pudendal neuropathy (with a total of n= 59 pudendal nerves). Of these, n=25 patients (n=29 nerves operated on) could be included in this retrospective study. Mean age was 54 years, n=15 were female, n= 10 male. Pre-OP symptoms were pain in n=25, sensory deficits in n=5 and motor deficits in n=6 patients. All patients received a preoperative, diagnostic pudendal nerve block. In n=29 procedures a dorsal transgluteal decompression (n=13 unilateral/ n=12 bilateral), and in n=4 a paraperineal approach (n=2 unilateral/ n=2 bilateral) was performed. Compression site consisted in n=15 in a hypertrophic sacrotuberous ligament. In n=16 cases we encountered additional pathologies: n=11 scarring, n=2 fibrous bands, n=2 sacrospinous ligament compression, n=1 perineural varicosis. No perioperative complications occurred. Overall postoperative pain intensity dropped significantly from 7.96 on Visual Analogue Scale (VAS) to 5.96 (p<0.0002). N=11 patients significantly (p<0.0145) improved their free time life activity. Overall well-being increased significantly (p<0.0001) in n=17 patients.

CONCLUSION: In our experience, surgical pudendal nerve decompression led to a significant improvement in the patient’s life quality. Careful patient selection and meticulous workup are mandatory for successful treatment. Further studies with larger patient groups and longer follow-up are required.