Advancing the diagnosis and management of pudendal nerve entrapment: The role of neurophysiological studies and imaging-guided infiltrations.

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY

Neuroradiology Pub Date : 2025-08-01 Epub Date: 2025-05-19 DOI:10.1007/s00234-025-03645-7

Cláudia Fernandes, Vanessa Viegas, Manuel Saavedra, Javier Casado, Ana Sánchez, Clara Velasco, Lidia Cabañes, Cecilia Luque, Alberto Artiles, Luís San José, Luís Lopez-Fando Lavalle

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引用次数: 0

Abstract

Purpose: Pudendal nerve entrapment (PNE) diagnosis is not standardized. This leads to diagnosis delays, impacting quality of life and therapeutic outcomes. The main goal is to find the role of neurophysiological study (NFS) and Imaging-guided pudendal nerve infiltration (ImPNI) in PNE diagnosis and patient selection for surgery.

Methods: A retrospective, multicentric study was conducted. Patients with PNE refractory to conservative treatment were included. Patient data, including NFS results, ImPNI, and surgical outcomes, were evaluated. A visual analogue scale was used to assess intervention response. Test performance metrics for NFS and ImPNI and binary logistic regression were used to determine their predictive value for postoperative improvement.

Results: 88 patients were diagnosed with PNE. All had NFS, and ImPNI was performed in 69 (78.4%), with 60 (68.2%) showing symptom improvement. Among the 40 patients (85%) who underwent pudendal nerve decompression surgery, 75% improved after surgery, and 20% did not. The combination of NFS and ImPNI showed a sensitivity of 79% and a specificity of 85.7%, with a Positive Predictive Value (PPV) of 98% and a Negative Predictive Value (NPV) of 30%. NFS and ImPNI were significant predictors of surgical success with p-values of 0.013 [ 95% CI: -23.6-19.9] and 0.003 [95% CI: -20.6 -18.5], respectively. Primary limitations: retrospective design and the absence of a control group.

Conclusions: NFS and ImPNI are essential and highly reliable tools for diagnosing PNE. ImPNI is a valuable predictor of surgical outcomes. These findings enable precise patient selection for surgery, ensuring optimal surgical outcomes.

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推进阴部神经卡压的诊断和治疗：神经生理学研究和成像引导浸润的作用。

目的：阴部神经卡压（PNE）诊断不规范。这导致诊断延误，影响生活质量和治疗结果。主要目的是发现神经生理学研究（NFS）和成像引导阴部神经浸润（ImPNI）在PNE诊断和手术患者选择中的作用。方法：采用回顾性、多中心研究。包括保守治疗难治性PNE患者。评估患者数据，包括NFS结果、ImPNI和手术结果。采用视觉模拟量表评估干预反应。NFS和ImPNI的测试性能指标和二元逻辑回归用于确定其术后改善的预测值。结果：88例患者确诊为PNE。所有患者均有NFS，其中69例（78.4%）行ImPNI， 60例（68.2%）症状改善。在40例（85%）接受阴部神经减压手术的患者中，75%的患者术后改善，20%没有。NFS联合ImPNI的敏感性为79%，特异性为85.7%，阳性预测值（PPV）为98%，阴性预测值（NPV）为30%。NFS和ImPNI是手术成功的重要预测因子，p值分别为0.013 [95% CI: -23.6-19.9]和0.003 [95% CI: -20.6 -18.5]。主要局限性：回顾性设计和缺乏对照组。结论：NFS和ImPNI是诊断PNE必不可少且高度可靠的工具。ImPNI是一个有价值的预测手术结果的指标。这些发现使精确的患者选择手术，确保最佳的手术结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.