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PubMed1997

Delivery and pudendal nerve function.

OBJECTIVE: To assess the impact of mode of delivery and the occurrence of pelvic instability upon the pudendal nerve function and relate the pudendal nerve function to the occurrence of anal and urinary incontinence. METHODS: One hundred and forty-six pregnant women were examined during pregnancy and 12 weeks post partum with measurement of pudendal nerve terminal motor latency (PNTML), the difference between the two measurements was defined as delta PNTML. Anal and urinary continence status, details of delivery and the occurrence of pelvic instability were recorded prospectively. RESULTS: Pudendal nerve terminal motor latency increased from 1.7 msec in primiparae and 1.8 msec in multiparae during pregnancy to 2.0 msec (p < 0.001) and 2.1 (p < 0.001) respectively after delivery. The increase was significantly higher after the use of vacuum extraction (p < 0.04). Multivariate analysis showed that delta PNTML was associated with age, the presence of pelvic instability and the use of vacuum extraction. Whereas delta PNTML was not associated with factors such as infant's head circumference and weight, parity, cesarean section, pudendal block, epidural analgesia and second stage of labor. Only four women had anal incontinence after delivery. Twenty-five women with urinary incontinence had a significantly higher mean PNTML (2.20 msec) than 121 continent women (2.01 msec). CONCLUSION: Pudendal nerve terminal motor latency increases in both primiparous and multiparous women after delivery. In 10% of the women the increase resulted in a pathologic PNTML value > 2.4 msec. The delta PNTML was significantly associated with age, the occurrence of pelvic instability and the use of vacuum extraction. The group of women with urinary incontinence had a significant increased PNTML.

Adult↗

PubMed2004

Restoration of external urethral sphincter function after pudendal nerve end-to-end anastomosis in the male rabbit.

PURPOSE: In this study we rehabilitated external urethral sphincter function by pudendal nerve end-to-end anastomosis after experimental pudendal nerve axotomy in male rabbits. MATERIALS AND METHODS: A total of 17 animals were included in this study, including group 1-a control group of 5 (29.4%), group 2-6 (35.3%) and group 3-6 (35.3%). Animals from group 2 underwent bilateral axotomy and group 3 underwent pudendal nerve end-to-end anastomosis. In all groups we performed urodynamic investigations prior to axotomy, after axotomy or anastomosis, and 14, 42 and 90 days after axotomy or nerve anastomosis. RESULTS: In untreated group 1 control sphincter pressure was 28.5 cm H2O. In group 2 average urethral sphincter pressure was 5.6 cm H2O 14 days after axotomy with only a slight increase to 11.05 cm H2O by day 90. In group 3 external urethral pressure increased to 8.26 cm H2O after 14 days and to 21.32 cm H2O by postoperative day 90. CONCLUSIONS: External urethral sphincter deficiency after bilateral pudendal nerve axotomy demonstrates the primacy of the pudendal nerve in the innervation of the external urethral sphincter. We were able to rehabilitate external urethral sphincter function by performing pudendal nerve end-to-end anastomosis.

Anastomosis, Surgical↗

PubMed1999

Laterality effects of human pudendal nerve stimulation on corticoanal pathways: evidence for functional asymmetry.

BACKGROUND: Although motor and sensory pathways to the human external anal sphincter are bilateral, a unilateral pudendal neuropathy may still disrupt anal continence. Anal continence can, however, be preserved despite unilateral pudendal damage, and so to explain those differing observations, we postulated that pudendal innervation might be asymmetric. AIMS: To explore the individual effects of right and left pudendal nerve stimulation on the corticofugal pathways to the human external anal sphincter and thus assess evidence for functional asymmetric pelvic innervation. METHODS: In eight healthy subjects, anal sphincter electromyographic responses, evoked to transcranial magnetic stimulation of the motor cortex, were recorded 5-500 msec after digital transrectal electrical conditioning stimuli applied to each pudendal nerve. RESULTS: Right or left pudendal nerve stimulation evoked anal responses of similar latencies but asymmetric amplitudes in six subjects: dominant responses (>50% contralateral side) from the right pudendal in four subjects and from the left in two. Cortical stimulation also evoked anal responses with amplitude 448 (121) microV and latency 20.9 (1.1) msec. When cortical stimulation was preceded by pudendal nerve stimulation, the cortical responses were facilitated at interstimulus intervals of 5-20 msec. Dominant pudendal nerve stimulation induced greater facilitation of the cortically evoked responses than the non-dominant nerve. CONCLUSIONS: Cortical pathways to the external anal sphincter are facilitated by pudendal nerve conditioning, in an asymmetric manner. This functional asymmetry may explain the presence and absence of anal incontinence after unilateral pudendal nerve injury.

Adult↗

PubMed2005

A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder: description of the method and preliminary data.

AIMS: Pudendal nerve stimulation has beneficial effects on numerous pelvic floor function impairments such as urinary and/or fecal incontinence, retention, and constipation. In preceding literature the implant technique required a fairly complex and invasive surgery, although recent advances with percutaneous placement of the lead through an introducer have made the procedure much less invasive. We performed staged procedure similar to that of sacral neuromodulation (SNM) to place tined lead near the pudendal nerve, using neurophysiological guidance that allowed accurate pudendal nerve stimulation through either perineal or posterior approach. We have named this approach chronic pudendal nerve stimulation (CPNS). METHODS: Fifteen neurogenic patients (eight male, seven female) with symptoms of urge incontinence due to neurogenic overactive bladder underwent CPNS. All patients had complete neurophysiological and urodynamic evaluation at baseline and follow-up and were asked to complete voiding and bowel diary for 7 days. RESULTS: During screening, average number of incontinent episodes per day decreased from 7+/-3.3 to 2.6+/-3.3 (P<0.02, paired t-test). Eight patients became continent, two improved by more than 88% (from 9 to 1 daily incontinence episode) and two patients reduced the number of incontinence episodes by 50%. The implantable pulse generator (IPG) was subsequently implanted in those 12 patients. Three patients without improvement did not continue to second stage. In implanted patients with 6 months follow-up, urodynamic evaluation showed an objective improvement in the maximum cystometric capacity which increased from 153.3+/-49.9 to 331.4+/-110.7 ml (P<0.01, paired t-test). The maximum pressure decreased from 66+/-24.3 to 36.8+/-35.9 cmH2O (P=0.059, paired t-test). Eight patients reported significant improvement in bowel function. CONCLUSION: Chronic pundedal nerve stimulation is feasible. Neurophysiological guidance is mandatory to place the lead near the pudendal nerve either using perineal or posterior approach. Further studies must be carried out to identify the best stimulation parameters and to verify the long term results.

Action Potentials↗

PubMed1997

Electrophysiological evidence for the nomenclature of the pudendal nerve and sacral plexus in the male rat.

Surgical microscopy and electrophysiological techniques were used to standardize the nomenclature for the pudendal nerve and sacral plexus according to their somatic axonal composition in the male rat. We conclude that the pudendal nerve is the segment running from the L6-S1 trunk to the sacral plexus, carrying efferent fibers to the coccygeus, internal obturator, ventral and dorsal bulbospongiosus, ischiocavernosus, external anal sphincter, and external urethral sphincter muscles, and afferent fibers from the penis, prepuce, scrotum, and ventral-proximal tail. The sacral plexus is the complex formed by the bridge-like structure connecting the pudendal nerve with the lumbosacral trunk, and two nerve branches emerging from it, one innervating the proximal half of the scrotal skin, and the other innervating the muscles at the base of the penis known as the motor branch. These branches are only considered as a part of the sacral plexus because they integrate axons from both the lumbosacral trunk and pudendal nerve. The gross anatomy of the pudendal nerve and sacral plexus has a main organization that was observed in 70% of cases, whereas the remaining 30% occurred in two variants. This nomenclature is appropriate to describe the pudendal nerve and sacral plexus in studies that involve them being lesioned or electrophysiologically analysed. A main additional finding was that two large afferent branches innervate the scrotum, one the proximal half and the other the distal half. As mentioned above, the proximal branch belongs to the sacral plexus, whereas the distal branch belongs to the pudendal nerve because all its axons travel to the cord via this nerve. Since stimulation or even manipulation of the scrotal branches resulted in the secretion of semen containing spermatozoa, it is suggested that scrotal afferents are involved in some way in the ejaculatory process, a topic that deserves further research.

Animals↗

PubMed1999

Results of pudendal nerve neurolysis-transposition in twelve patients suffering from pudendal neuralgia.

PURPOSE: Pudendal neuralgia caused by nerve compression may be improved by surgical decompression of the pudendal nerve. This study was undertaken to determine if clinical symptoms, electrophysiological investigations, and the efficacy of preoperative pudendal nerve blocks could be used to predict the efficacy of surgery. METHODS: Twelve consecutive patients complaining of anal pain, genital pain, or both, exacerbated in the sitting position and unsuccessfully treated by analgesic drugs before referral were studied. In these 12 patients decompression of the pudendal nerve was performed after unsuccessful CT-guided injection of corticosteroids in the pudendal nerve at the ischial spine or after pain relapse following successful injections. Nineteen nerves were decompressed by surgery, and the compressed area was located between the sacrospinal and sacrotuberal ligaments for 18 nerves. RESULTS: Three months after surgery, four patients were totally relieved, and three were only partially improved. After 21 months of follow-up, three patients were cured, one was slightly improved, and eight remained in pain. In the three patients cured by surgery, pain completely disappeared for at least two weeks after a nerve block repeated twice before surgery, whereas pain relief was observed in only one of the nine other patients (P = 0.018). None of the three patients cured by surgery were being treated for depression, whereas six of the nine remaining patients were receiving antidepressants or were followed by a psychiatrist (P = 0.09). Results of surgery did not depend on other preoperative clinical or electrophysiological data. CONCLUSIONS: This preliminary study suggests that complete disappearance of pain for at least two weeks after a nerve block repeated twice before surgery may be the best criterion to predict success. Based on this criterion, surgery would have been performed in four patients in this study, of whom three would have been cured.

Aged↗

PubMed2004

[Reconstruction of the anus by the gracilis muscle reinnervated by the pudendal nerve. A preliminary anatomical study].

UNLABELLED: The aim of this study is to evaluate the possibilities of reinnervation of the gracilis muscle, transposed around the anus, by the pudendal nerve with an end-to-side nerve anastomosis. METHODS: This study was carried out in 10 cases. The gracilis muscle and its vascular-nervous pedicle have been dissected. The nerve of the gracilis muscle has been cut at its origin. The gracilis muscle was transposed around the anus. The nerve of the gracilis muscle was transposed in the gluteal area. The pudendal nerve has been dissected from its extra-pelvic part. The reinnervation with an end-to-side nerve anastomosis has been considered as feasible when the proximal ending of the nerve of the gracilis was put into a tension free contact with the extra-pelvic part of the pudendal nerve. RESULTS: The reinnervation of the gracilis muscle by the pudendal nerve has been possible in all cases. The extra-pelvic part of the pudendal nerve has a common trunk in 8 cases. The width of the extra-pelvic part of the pudendal nerve was 2.8 +/- 0.8 mm (1-3.5). The width of the proximal endings of the nerve innervating the gracilis muscle was 2.5 +/- 0.5 mm (2-3). After transposition of the nerve of the gracilis muscle in the gluteal area an average supplementary length of 20.9 +/- 16.8 mm was available (range 5-52). CONCLUSIONS: These results suggest that a reconstruction of the anal sphincter with a gracilis muscle transposed around the anus and reinnervated by the pudendal nerve with end-to-side nerve anastomosis is possible.

Aged↗

PubMed2001

New, simple, ultrasound-guided infiltration of the pudendal nerve: ultrasonographic technique.

PURPOSE: Anesthetic infiltration of the pudendal nerve at the ischial spine can relieve perineal pain in cases of compression or distention. The aim of our study was to look for a real-time, visually controlled infiltration technique using ultrasound. METHODS: Fifty-three volunteers were examined in a prone position using a 3.5-MHz curved-array probe in color-coded Doppler mode. The deep gluteal region was scanned in two perpendicular planes, longitudinal and transverse to the internal pudendal artery. RESULTS: On the transverse planes the ischial spine, the sacrospinous ligament, and the internal pudendal artery were depicted in all but two cases. In 47.2 percent of the cases one trunk of the pudendal nerve was detected directly. Nerves consisting of more than one trunk were not found. The thickness of the nerve ranged between 3.5 and 7 mm. CONCLUSIONS: In almost one-half of the cases a direct ultrasound-guided infiltration of the pudendal nerve is possible. In the remaining cases the nerve can be detected and blocked indirectly, using the ischial spine or the internal pudendal artery as a landmark.

Adolescent↗

PubMedDate not supplied

Short-term timecourse of bilateral pudendal nerve injury on leak-point pressure in female rats.

The pudendal nerve innervates the external urethral sphincter and, when injured, can contribute to incontinence development. This experiment was designed to study the time course of functional changes in the urethra after pudendal nerve crush in rats. Leak-point pressure (LPP) was measured 2, 4, 7, or 14 days after bilateral pudendal nerve crush and was compared to that of a control group. LPP at all four time points after nerve injury was significantly decreased compared to control values. A minimum was reached 4 days after injury, and LPP appeared to trend upward with increasing time after injury, suggesting that nerve function may begin to recover or compensatory changes in the urethra may occur. Pudendal nerve crush induces decreased LPP in female rats, mimicking the clinical symptoms of stress incontinence. When fully characterized, this model could be useful for preclinical testing of treatment and rehabilitation protocols.

Animals↗

PubMed1998

Pudendal canal syndrome as a cause of vulvodynia and its treatment by pudendal nerve decompression.

Notwithstanding many established causes of vulvodynia there still remains an idiopathic group with unknown etiology and variable results of treatment. We present 11 women with idiopathic vulvodynia in whom the etiology could be defined and who were successfully treated. Age varied from 28-53 years. The vulvar pain was associated with stress urinary incontinence in 6/11 patients and all had constipation. Perineal and vulvar hypoesthesia occurred in 6, weak anal reflex in 7 and diminished EMG activity of the external anal sphincter in 3, of the external urethral sphincter in 6 and of the levator ani muscle in 11. There was significant increase (P<0.05) of the pudendal nerve terminal motor latency (PNTML) in all. The motor and sensory change as well as the increased PNTML point to pudendal canal syndrome. Pudendal nerve block, as a diagnostic and therapeutic test, effected temporary pain relief. Pudendal nerve decompression was performed. The inferior rectal nerve was exposed through a para-anal incision, and followed to the pudendal nerve in the pudendal canal. Pudendal canal fasciotomy was done to release the pudendal nerve in the ischiorectal fossa. Vulvar pain disappeared in 9/11 women and stress urinary incontinence in 4/6. Anal reflex was normalized in 5/7 women, and vulvar and perineal hypoesthesia in 4/6. The EMG activity of the external urethral sphincter improved in 4/6, of the external anal sphincter in 2/3 and of the levator ani in 9/11 women. The PNTML was normalized in 9/11 women. In conclusion, pudendal nerve decompression effected relief and improvement in the sensory and motor manifestations of the pudendal nerve in 9/11 women. Two women did not improve due probably to an irreversible damage of the pudendal nerve, or to incomplete pudendal nerve decompression.

Adult↗

PubMed1994

Pudendal nerve damage during labour: prospective study before and after childbirth.

OBJECTIVE: To establish the effect of childbirth on pudendal nerve function and identify obstetric factors associated with such damage. DESIGN: A prospective investigational study. SETTING: Antenatal clinic, St Bartholomew's (Homerton) Hospital. SUBJECTS: One hundred and twenty-eight unselected pregnant women beyond 34 weeks' gestation. INTERVENTION: Pudendal nerve terminal motor latencies (PNTML) and perineal plane were measured during pregnancy and six to eight weeks after delivery, and remeasured in a subgroup (n = 22) at six months. MAIN OUTCOME MEASURES: Effect of mode of delivery on PNTML and the plane of the perineum. RESULTS: Vaginal delivery resulted in a significant (P < 0.0001) prolongation of the mean PNTML bilaterally in both primipara (n = 57) 1.91 ms (SD 0.19) vs 2.00 ms (SD 0.22), antenatal vs postnatal, right PNTML; 1.96 ms (SD 0.21) vs 2.06 ms (SD 0.24) left PNTML, and multipara (n = 32) (P < 0.01). Perineal descent during straining was also increased after vaginal delivery (P < 0.001). Greater damage to the pudendal nerve occurred on the left side (P = 0.03). PNTML were not altered after elective caesarean section (n = 7), but were increased on the left side when caesarean section was performed during labour (1.94 ms (SD 0.13) vs 2.08 ms (SD 0.29), P < 0.01). A heavier baby and a longer active second stage of labour were both associated with significant prolongation of PNTML. Eight out of 12 women with a prolonged PNTML at six weeks had normal measurements when restudied six months after delivery. CONCLUSION: Vaginal delivery, particularly the first, results in significant pelvic floor tissue stretching and pudendal nerve damage. Women who have a caesarean section during labour may also be at risk of pudendal nerve damage. The process of labour and vaginal delivery can both cause pudendal nerve damage which may be asymmetrical in extent.

Action Potentials↗

PubMedDate not supplied

Anatomy of the pudendal nerve and its terminal branches: a cadaver study.

BACKGROUND: This study documents the anatomy of the pudendal nerve, which has a major role in maintaining faecal continence. Unexpected faecal incontinence can develop following perineal surgery even when the anal sphincters are not damaged. In addition, injury to the pudendal nerve might be encountered during pelvic procedures such as a sacrospinous colpopexy. METHODS: An anatomical study on 28 cadavers was conducted to examine the course of the pudendal nerve and its branches in the perineum. RESULTS: In five of the 28 cadavers dissected (four male, one female), a nerve plexus was found within the ischiorectal fossa in close proximity to the anal sphincters. The plexus received contributions from interconnecting branches of the inferior rectal and perineal nerves to innervate the external anal sphincter. In 11 of the 28 cadavers (five female, six male) an additional nerve arose from the medial aspect of the pudendal nerve at the level of the sacrotuberous and sacrospinous ligaments. This nerve continued distally and gave several branches to the perineum and the levator ani muscle. CONCLUSION: A sound knowledge of the anatomical variations of the pudendal nerve and its branches is essential for all surgeons operating in the perineal region.

Aged↗

PubMed2004

Block of external urethral sphincter contraction by high frequency electrical stimulation of pudendal nerve.

PURPOSE: High frequency electrical stimulation (1 to 10 kHz) of the pudendal nerve was evaluated as a method to block the external urethral sphincter contractions and increases in intraurethral pressure induced by electrical stimulation of pudendal nerve efferent axons. MATERIALS AND METHODS: Two stainless steel electrodes were positioned 5 to 10 mm apart on the decentralized pudendal nerve in alpha-chloralose anesthetized cats. The most central electrode was electrically stimulated (40 Hz) to activate the efferent input to the external urethral sphincter. The change in the neurally evoked urethral responses by high frequency electrical stimulation of the distal electrode using a sinusoidal waveform or biphasic charge balanced pulses was examined. RESULTS: For the 2 waveforms stimulation frequencies between 6 and 10 kHz were most effective in blocking external urethral sphincter activation. Intraurethral pressures caused by contractions of the external urethral sphincter were decreased more than 90% by high frequency stimulation using effective frequencies. When high frequency stimulation was turned off, external urethral sphincter responses recovered rapidly. CONCLUSIONS: Reversible block of the external urethral sphincter contractions by high frequency electrical stimulation of the pudendal nerves is a potential method for suppressing detrusor-sphincter dyssynergia and improving voiding in spinal cord injured patients.

Animals↗

PubMed1997

Treatment of external urethral sphincter hypertonicity by pudendal nerve block using phenol solution in patients with spinal cord injury.

We report our experience utilizing the technique of phenol block of the pudendal nerve in the treatment of voiding dysfunction due to hypertonicity of the external urethral sphincter. We have performed 13 pudendal nerve blocks using a 7% phenol solution in seven patients with spinal cord injury who could not obtain relaxation of the external urethral sphincter with a large postvoid urine residual (150 ml to 600 ml) despite large doses of antispasticity drugs and intermittent catheterisations over three weeks. These drugs were discontinued at least 48 hours before this procedure. The efficacy of the pudendal nerve block could also be tested by the ease of facilitating micturition during or just after the block and measuring the amount of postvoid residual urine and intravesical leak pressure. A pudendal nerve block was produced by injecting a 7% phenol solution medial to the ischial tuberosity having specifically localized the nerve by electrical stimulation. This procedure improved the voiding pattern dramatically, leading to a full stream of urine and a remarkable decrease of postvoid residual volume and intravesical leak pressure. The mean difference of the postvoid residual volume and the intravesical leak pressure before and after pudendal nerve block was 255.7 ml and 57.5 cmH2O, respectively. We conclude that pudendal nerve block with a phenol solution as a treatment of external urethral sphincter hypertonicity was effective, easy to perform, and had no complication. This treatment should be considered as a possible alternative to more invasive surgical procedures.

Adult↗

PubMed2001

Pudendal nerve conduction to evaluate organic erectile dysfunction.

OBJECTIVE: This study aimed to evaluate the value of testing pudendal nerve conduction in men with erectile dysfunction. DESIGN: This open prospective study was conducted on 150 men with documented erectile dysfunction of at least 6 mo of duration, all of whom underwent pudendal nerve conduction by the same investigator. RESULTS: Only patients with erectile dysfunction and low back pain (n = 9) showed statistically significant prolonged pathologic pudendal nerve conduction latency of 43.1 msec/div (SD +/- 11.3 msec/div, P < 0.05). There were no correlations between the pudendal nerve conduction latency in patients suffering from erectile dysfunction associated with diabetes mellitus, local trauma, pelvic surgery, or antihypertensive drugs. CONCLUSIONS: Pudendal nerve conduction may contribute valuable information to the evaluation of patients with erectile dysfunction caused by neurologic deficits as manifested by low back pain.

Adult↗

PubMed1987

Central distribution of efferent and afferent components of the pudendal nerve in rat.

Central distribution of efferent and afferent components of the pudendal nerve was examined in the rat by the horseradish peroxidase (HRP) method after HRP application to the central cut end of the pudendal nerve. The pudendal motoneurons were located in the dorsolateral, dorsomedial and lateral groups at L5 and L6. Each of the dorsolateral and dorsomedial groups constituted a slender longitudinal cell column. Pudendal motoneurons in the lateral group were scattered at L5, rostrodorsally to the dorsolateral group. The neurons in the dorsolateral and lateral groups were labelled with HRP applied to the nerve branch innervating the ischiocavernosus and sphincter urethrae muscles. The neurons in the dorsomedial group were labelled with HRP applied to the branch supplying the sphincter ani externus and bulbospongiosus muscles. Some dendrites of pudendal motoneurons in the dorsomedial group extended to the contralateral dorsomedial group. These crossing dendrites were observed not only in male rats but also in female. The average number of the pudendal motoneurons in the dorsolateral and dorsomedial groups were larger in male rats than in female. A few neurons of the intermediolateral nucleus at upper L6 were also labelled with HRP applied to the dorsalis penis (clitoridis) nerve. Axon terminals of the pudendal nerve were distributed, bilaterally with an ipsilateral predominance, to the gracile nucleus, as well as to the dorsal horn and dorsal commissural gray from L4 to S2. A few labelled axons were seen in the intermediolateral nucleus at L6 and S1. Axon terminals from the dorsalis penis nerve were distributed more medially in the dorsal horn than those from the perinealis nerve.

Animals↗

PubMed2002

Motor pudendal nerve characterization in the female rat.

The aim of our study was to provide quantitative data on pudendal motor neuron cell bodies and axons in the female rat. To confirm earlier studies, fluorescent retrograde tracers were used to label the motor neurons for correlation with myelinated axon counts along the length of the motor pudendal nerve. The external urethral sphincter of female rats was injected with diamidino yellow and the external anal sphincter with fast blue. The L(6) spinal cord revealed labeled motor neurons. Those in the dorsolateral column (60.8 +/- 10.6) had nuclei labeled yellow from the external urethral sphincter and those in the dorsomedial column (31.7 +/- 8.5) had cytoplasm labeled blue from the external anal sphincter. Double labeling was not present, suggesting that pudendal motor neurons in each column innervate separate sphincters. The motor pudendal nerve in the ischiorectal fossa was also characterized by light microscopy. The mean myelinated axon count (151.4 +/- 17.0) was highly correlated (r = 0.995) in the proximal fascicles and the sum of distal fascicles. This indicated that myelinated axons do not branch at the point where the main motor pudendal nerve branches into separate fascicles. Axon counts between sides were not as well correlated (r = 0.883). The ratio of motor neurons to myelinated axons is 56%, suggesting that some myelinated axons either innervate other muscles or are sensory. This reproducible characterization of the normal pudendal nerve anatomy provides an excellent basis for experimental studies associated with pudendal nerve denervation as a model for neurogenic incontinence.

Anal Canal↗

PubMed2004

Unilateral pudendal nerve blockade for relief of all pain during transrectal ultrasound-guided biopsy of the prostate: a randomized, double-blind, placebo-controlled study.

OBJECTIVES: To investigate the efficacy of unilateral pudendal nerve block for the relief of all pain during transrectal ultrasound (TRUS)-guided prostate biopsy. TRUS-guided prostate biopsy is the standard procedure to diagnose or rule out prostate cancer. The pain, attributed to ultrasound probe insertion and the needle punctures into the prostate, inflicted by TRUS-guided prostate biopsy limits its effectiveness. METHODS: We performed a prospective, randomized, double-blind, placebo-controlled study of 65 consecutive men suspected of having prostate cancer who were undergoing TRUS-guided prostate biopsy, 51 of whom fulfilled the inclusion criteria. Before the biopsy, each patient was randomized to one of two groups. Both the patient and the physician who performed the TRUS-guided biopsy were unaware of the contents of the injection for the pudendal nerve block. Unilateral pudendal nerve blockade was performed transperineally with digital rectal examination guidance using 10 mg of 1% prilocaine (group 1 [n = 26]) or 10 mL of a 0.9 NaCl solution (group 2 [n = 25]) by way of a 22-gauge spinal needle by the same anesthetist. Pain was evaluated using an 11-point visual analog scale questionnaire. RESULTS: No statistically significant differences were found in the visual analog scale score for pain during the pudendal nerve blockade or digital rectal examination between the groups. A statistically significant difference was found in the visual analog scale score for the biopsy procedure (P < 0.01) and probe discomfort (P < 0.05) between the two groups. CONCLUSIONS: Unilateral pudendal nerve blockade was effective in reducing the pain at both biopsy and probe manipulation in our study.

Aged↗