Recommendations on the management of pudendal nerve entrapment syndrome: A formalised expert consensus
Corresponding Author
Amélie Levesque
Urology Department, Nantes University Hospital, Nantes, France
Correspondence
Amélie Levesque, Federative Pelvic Pain Center, Nantes University Hospital, Service d'urologie, 1, place Alexis Ricordeau, 44 093 Nantes, France.
Email: [email protected]
Search for more papers by this authorEric Bautrant
Pelvi-Perineal Surgery and Rehabilitation Department, Private Medical Centre “l'Avancée-Clinique Axium”, Aix en Provence, France
Search for more papers by this authorVirginie Quistrebert
Urology Department, Nantes University Hospital, Nantes, France
Search for more papers by this authorThibault Riant
Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine de Sienne, Nantes, France
Search for more papers by this authorMarc Beer Gabel
Neurogastroenterology and Pelvic Floor Unit, Sheba Medical Center, Tel Hashomer, Israel
Search for more papers by this authorAnne-Marie Leroi
Physiology Department, Rouen University Hospital, Rouen, France
Search for more papers by this authorKatleen Jottard
Department of Surgery, Brugmann Hospital, Brussels, Belgium
Search for more papers by this authorLuc Bruyninx
Department of Surgery, Brugmann Hospital, Brussels, Belgium
Search for more papers by this authorGerard Amarenco
GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
Search for more papers by this authorLara Quintas
Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Faculty of Medicine, Barcelona, Spain
Search for more papers by this authorPascale Picard
Neurology Department, Clermont-Ferrand University Hospital, Inserm, Clermont-Ferrand, France
Search for more papers by this authorThierry Vancaillie
School of Women and Children, University of New South Wales, Sydney, New South Wales, Australia
Search for more papers by this authorChristine Leveque
Pelvi-Perineal Surgery and Rehabilitation Department, Private Medical Centre “l'Avancée-Clinique Axium”, Aix en Provence, France
Search for more papers by this authorFrédérique Mohy
Pain Management Center, University Hospital Felix Guyon, SAINT DENIS, La Reunion, France
Search for more papers by this authorBruno Rioult
Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine de Sienne, Nantes, France
Search for more papers by this authorStéphane Ploteau
Department of Gynecology-Obstetrics and Reproductive Medicine, Nantes University Hospital, Nantes, France
Search for more papers by this authorJean-Jacques Labat
Urology Department, Nantes University Hospital, Nantes, France
Search for more papers by this authorAmandine Guinet-Lacoste
Hospices Civils de Lyon, Hôpital Henry Gabrielle, Plate-forme Mouvement et Handicap, Lyon, France
Search for more papers by this authorBertrand Quinio
Pain Center, Regional University Hospital la Cavale Blanche, Brest, France
Search for more papers by this authorMichel Cosson
Departement of Gynecology, University Hopsital Jeanne De Flandre, Lille, France
Search for more papers by this authorRebecca Haddad
GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
Search for more papers by this authorXavier Deffieux
Department of Obstetrics and Gynecology, Antoine Beclere Hospital, Assistance Publique Hopitaux de Paris, Clamart University Paris-Saclay, Clamart, France
Search for more papers by this authorMarie-Aimée Perrouin-Verbe
Urology Department, Nantes University Hospital, Nantes, France
Search for more papers by this authorRoger Robert
Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine de Sienne, Nantes, France
Search for more papers by this authorCorresponding Author
Amélie Levesque
Urology Department, Nantes University Hospital, Nantes, France
Correspondence
Amélie Levesque, Federative Pelvic Pain Center, Nantes University Hospital, Service d'urologie, 1, place Alexis Ricordeau, 44 093 Nantes, France.
Email: [email protected]
Search for more papers by this authorEric Bautrant
Pelvi-Perineal Surgery and Rehabilitation Department, Private Medical Centre “l'Avancée-Clinique Axium”, Aix en Provence, France
Search for more papers by this authorVirginie Quistrebert
Urology Department, Nantes University Hospital, Nantes, France
Search for more papers by this authorThibault Riant
Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine de Sienne, Nantes, France
Search for more papers by this authorMarc Beer Gabel
Neurogastroenterology and Pelvic Floor Unit, Sheba Medical Center, Tel Hashomer, Israel
Search for more papers by this authorAnne-Marie Leroi
Physiology Department, Rouen University Hospital, Rouen, France
Search for more papers by this authorKatleen Jottard
Department of Surgery, Brugmann Hospital, Brussels, Belgium
Search for more papers by this authorLuc Bruyninx
Department of Surgery, Brugmann Hospital, Brussels, Belgium
Search for more papers by this authorGerard Amarenco
GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
Search for more papers by this authorLara Quintas
Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Faculty of Medicine, Barcelona, Spain
Search for more papers by this authorPascale Picard
Neurology Department, Clermont-Ferrand University Hospital, Inserm, Clermont-Ferrand, France
Search for more papers by this authorThierry Vancaillie
School of Women and Children, University of New South Wales, Sydney, New South Wales, Australia
Search for more papers by this authorChristine Leveque
Pelvi-Perineal Surgery and Rehabilitation Department, Private Medical Centre “l'Avancée-Clinique Axium”, Aix en Provence, France
Search for more papers by this authorFrédérique Mohy
Pain Management Center, University Hospital Felix Guyon, SAINT DENIS, La Reunion, France
Search for more papers by this authorBruno Rioult
Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine de Sienne, Nantes, France
Search for more papers by this authorStéphane Ploteau
Department of Gynecology-Obstetrics and Reproductive Medicine, Nantes University Hospital, Nantes, France
Search for more papers by this authorJean-Jacques Labat
Urology Department, Nantes University Hospital, Nantes, France
Search for more papers by this authorAmandine Guinet-Lacoste
Hospices Civils de Lyon, Hôpital Henry Gabrielle, Plate-forme Mouvement et Handicap, Lyon, France
Search for more papers by this authorBertrand Quinio
Pain Center, Regional University Hospital la Cavale Blanche, Brest, France
Search for more papers by this authorMichel Cosson
Departement of Gynecology, University Hopsital Jeanne De Flandre, Lille, France
Search for more papers by this authorRebecca Haddad
GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
Search for more papers by this authorXavier Deffieux
Department of Obstetrics and Gynecology, Antoine Beclere Hospital, Assistance Publique Hopitaux de Paris, Clamart University Paris-Saclay, Clamart, France
Search for more papers by this authorMarie-Aimée Perrouin-Verbe
Urology Department, Nantes University Hospital, Nantes, France
Search for more papers by this authorRoger Robert
Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine de Sienne, Nantes, France
Search for more papers by this authorFunding information
The translation fees were paid by ConvergencesPP.
Abstract
Background
Since the development and publication of diagnostic criteria for pudendal nerve entrapment (PNE) syndrome in 2008, no comprehensive work has been published on the clinical knowledge in the management of this condition. The aim of this work was to develop recommendations on the diagnosis and the management of PNE.
Methods
The methodology of this study was based on French High Authority for Health Method for the development of good practice and the literature review was based on the PRISMA method. The selected articles have all been evaluated according to the American Society of Interventional Pain Physicians assessment grid.
Results
The results of the literature review and expert consensus are incorporated into 10 sections to describe diagnosis and management of PNE: (1) diagnosis of PNE, (2) patients advice and precautions, (3) drugs treatments, (4) physiotherapy, (5) transcutaneous electrostimulations (TENS), (6) psychotherapy, (7) injections, (8) surgery, (9) pulsed radiofrequency, and (10) Neuromodulation. The following major points should be noted: (i) the relevance of 4+1 Nantes criteria for diagnosis; (ii) the preference for initial monotherapy with tri-tetracyclics or gabapentinoids; (iii) the lack of effect of opiates, (iv) the likely relevance (pending more controlled studies) of physiotherapy, TENS and cognitive behavioural therapy; (v) the incertitudes (lack of data) regarding corticoid injections, (vi) surgery is a long term effective treatment and (vii) radiofrequency needs a longer follow-up to be currently proposed in this indication.
Conclusion
These recommendations should allow rational and homogeneous management of patients suffering from PNE. They should also allow to shorten the delays of management by directing the primary care.
Significance
Pudendal nerve entrapment (PNE) has only been known for about 20 years and its management is heterogeneous from one practitioner to another. This work offers a synthesis of the literature and international experts' opinions on the diagnosis and management of PNE.
CONFLICT OF INTEREST
A conflict of interest agreement was requested from each of the participating experts. No conflicts of interest were declared by the authors.
Supporting Information
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| ejp1861-sup-0001-AppendixS1.docxWord 2007 document , 180.2 KB | Appendix S1 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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