Abstract
Development of chronic pelvic pain after laser resection for benign prostatic hypertrophy
has not been described previously (Clavien IIIb complication). The etiology of this
chronic pain, which persisted despite medical chronic pain and urologic management
for 5 years, was proven to be of pudendal nerve origin by local anesthetic blockade
of the pudendal nerves bilaterally at the ischial spines. Surgical treatment was based
upon the anatomic proximity of the perineal and dorsal branches of the pudendal nerve
to the site of laser therapy on the pelvic side of the urogenital diaphragm. Treatment
required resection of the perineal branches of the pudendal nerve bilaterally and
neurolysis of the dorsal nerve to the penis bilaterally through incisions overlying
the inferior pubic ramus. Relief of perineal pain and pain with micturition occurred
in the immediate postoperative period. Pain relief and resumption of all normal activity
occurred by 3 months postoperatively and continues 13 months following the surgery.
Keywords
prostatectomy - pudendal nerve - laser
