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J Reconstr Microsurg 2017; 33(06): 395-401
DOI: 10.1055/s-0037-1599130
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Injury to Perineal Branch of Pudendal Nerve in Women: Outcome from Resection of the Perineal Branches

Eric L. Wan
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Andrew T. Goldstein
2   The Centers for Vulvovaginal Disorders, Washington, DC
,
Hillary Tolson
2   The Centers for Vulvovaginal Disorders, Washington, DC
,
A. Lee Dellon
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
3   Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Publikationsverlauf

30. Oktober 2016

07. Januar 2017

Publikationsdatum:
04. März 2017 (online)

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Abstract

Background This study describes outcomes from a new surgical approach to treat “anterior” pudendal nerve symptoms in women by resecting the perineal branches of the pudendal nerve (PBPN).

Methods Sixteen consecutive female patients with pain in the labia, vestibule, and perineum, who had positive diagnostic pudendal nerve blocks from 2012 through 2015, are included. The PBPN were resected and implanted into the obturator internus muscle through a paralabial incision. The mean age at surgery was 49.5 years (standard deviation [SD] = 11.6 years) and the mean body mass index was 25.7 (SD = 5.8). Out of the 16 patients, mechanisms of injury were episiotomy in 5 (31%), athletic injury in 4 (25%), vulvar vestibulectomy in 5 (31%), and falls in 2 (13%). Of these 16 patients, 4 (25%) experienced urethral symptoms. Outcome measures included Female Sexual Function Index (FSFI), Vulvar Pain Functional Questionnaire (VQ), and Numeric Pain Rating Scale (NPRS).

Results Fourteen patients reported their condition pre- and postoperatively. Mean postoperative follow-up was 15 months. The overall FSFI, and arousal, lubrication, orgasm, satisfaction, and pain domains significantly improved (p < 0.05). The VQ also significantly improved (p < 0.001) in 13 (93%) of 14 patients. The NPRS score decreased on average from 8 to 3 (p < 0.0001). All four patients with urethral symptoms were relieved of these symptoms.

Conclusion Resection of the PBPN with implantation of the nerve into the obturator internus muscle significantly reduced pain and improved sexual function in women who sustained injury to the PBPN.

Keywords

pelvic pain - pudendal nerve injury - neuroma