Pelvic neuropathic pain (differential diagnosis)
Authors:
Fučík T.; Mašata J.
Authors‘ workplace:
Gynekologicko-porodnická klinika 1. LF UK a VFN v Praze
Published in:
Ceska Gynekol 2021; 86(4): 279-283
Category:
Review Article
doi:
https://doi.org/10.48095/cccg2021279
Overview
Objective: General practitioners, surgeons, neurologists, urologists and gynecologists all encounter patients suffering from neurogenic pelvic pain. Correct management demands knowledge from all above mentioned specialties. The primary goal is to help patients suffering from chronic or acute pelvic pain coupled with functional disorders like dysuria, urgency, dyspareunia, mobility disorders orhypoesthesia. Neurogenic defects are not the most common etiology for either of listed symptoms. However, after exclusion of the more common ones and failure to respond to basic therapeutic methods such as physiotherapy or analgotheraphy doctors tend to mark the illness as idiopathic and incurable. The goal of this review is to show the most common nosological units and a robust diagnostic algorithm to describe the type and level of the damage. Methods: Review of literature using databases Pubmed, Science direct, Medline and sources of the international school of neuropelveology. Conclusion: Over a lifetime, one in seven women will suffer from chronic pelvic pain. Outside of the cases where a clear postoperative etiology is established, the time to make a correct diagnosis is often long for the unspecific and varied symptomatology. Neuropelveological diagnostic algorithm is demonstrably efficient in shortening the time to diagnosis and more importantly to the treatment.
Keywords:
chronic pelvic pain – pudendal neuralgia – neuropelveology – decompression and neurolysis – pelvic congestion syndromes
Sources
1. Lamvu G, Williams R, Zolnoun D et al. Long-term outcomes after surgical and nonsurgical management of chronic pelvic pain: one year after evaluation in a pelvic pain specialty clinic. Am J Obstet Gynecol 2006; 195 (2): 591–600. doi: 10.1016/j.ajog.2006.03.081.
2. Latthe P, Latthe M, Say L et al. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health 2006; 6: 177. doi: 10.1186/1471-2458-6-177.
3. Ahlberg NE, Bartley O, Chidekel N. Right and left gonadal veins. An anatomical and statistical study. Acta Radiol Diagn (Stockh) 1966; 4 (6): 593–601. doi: 10.1177/028418516600400 601.
4. 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.
5. Goldstein AT, Pukall CF, Brown C et al. Vulvodynia: assessment and treatment. J Sex Med 2016; 13 (4): 572–590. doi: 10.1016/j.jsxm.2016.01. 020.
6. Lemos N, Possover M. Laparoscopic approach to intrapelvic nerve entrapments. J Hip Preserv Surg 2015; 2 (2): 92–98. doi: 10.1093/jhps/ hnv030.
7. Labatt 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.
8. 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.
9. O‘Brien MT, Gillespie DL. Diagnosis and treatment of the pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord 2015; 3 (1): 96–106. doi: 10.1016/j.jvsv.2014.05.007.
10. Wang XH, Xu JJ, Yang G et al. Impact of ultrasound diagnosis for chronic pelvic pain. Medicine (Baltimore) 2019; 98 (39): e17281. doi: 10.1097/MD.00000000000017281.
11. Boogaard S, Heymans MW, de Vet HC et al. Predictors of persistent neuropathic pain – a systematic review. Pain Physician 2015; 18 (5): 433–457.
12. Shafik A, el-Sherif M, Youssef A et al. Surgical anatomy of the pudendal nerve and its clinical implications. Clin Anat 1995; 8 (2): 110–115. doi: 10.1002/ca.980080205.
13. Soon-Sutton TL, Feloney MP, Antolak S. Pudendal neuralgia. In: StatPearls. Treasure Island (FL): StatPearls Publishing 2021. 2021 [online]. Available from: www.ncbi.nlm.nih.gov/books/NBK430685/.
14. Aló KM, Holsheimer J. New trends in neuromodulation for the management of neuropathic pain. Neurosurgery 2002; 50 (4): 690–703. doi: 10.1097/00006123-200204000-00003.
15. Katz R, Golijanin D, Pode D et al. Primary and postoperative retroperitoneal fibrosis – experience with 18 cases. Urology 2002; 60 (5): 780–783. doi: 10.1016/s0090-4295 (02) 01910-6.
16. 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.
17. Martinez A, Howard FM. The efficacy of laparoscopic surgical treatment of ovarian remnant and ovarian retention syndromes. J Minim Invasive Gynecol 2015; 22 (2): 245–249. doi: 10.1016/j.jmig.2014.10.007.
18. Raffetto JD, Qiao X, Beauregard KG et al. Estrogen receptor-mediated enhancement of venous relaxation in female rat: implications in sex-related differences in varicose veins. J Vasc Surg 2010; 51 (4): 972–981. doi: 10.1016/ j.jvs.2009.11.074.
19. Ploteau S, Cardaillac C, Perrouin-Verbe MA et al. Pudendal neuralgia due to pudendal nerve entrapment: warning signs observed in two cases and review of the literature. Pain Physician 2016; 19 (3): E449–E454.
20. Mára M, Fučíková Z, Kužel D et al. Laparoskopie pro chronickou pánevní bolest – retrospektivní klinická studie. Ceska Gynekol 2002; 67 (1): 38–46.
21. Possover M. Neuropelveology: an emerging discipline for the management of pelvic neuropathies and bladder dysfunctions through to spinal cord injury, anti-ageing and the mars mission. J Clin Med 2020; 9 (10): 3285. doi: 10.3390/jcm9103285.
22. Penzias A, Bendikson K, Falcone T et al. Postoperative adhesions in gynecologic surgery: a committee opinion. Fertil Steril 2019; 112 (3): 458–463. doi: 10.1016/j.fertnstert.2019.06.027.
23. Homola P, Hensel G, Škorničková Z et al. Exstirpace suburetrální pásky z důvodu chronických bolestí. Ceska Gynekol 2017; 82 (4): 313–317.
24. Possover M, Schneider T, Henle KP. Laparoscopic therapy for endometriosis and vascular entrapment of sacral plexus. Fertil Steril 2011; 95 (2): 756–758. doi: 10.1016/j.fertnstert.2010.08.048.
25. Gulur P, Nelli A. Persistent postoperative pain: mechanisms and modulators. Curr Opin Anaesthesiol 2019; 32 (5): 668–673. doi: 10.1097/ACO.0000000000000770.
26. Asiri MD, Banjar R, Al-Qahtani W et al. Central nervous system changes in pelvic inflammation/pain patients. Curr Bladder Dysfunct Rep 2019; 14 (8): 223–230. doi: 10.1007/s11884-019-00530-x.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
2021 Issue 4
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