The role of urodynamic study in pudendal nerve entrapment syndrome

Introductions and aims:

Pudendal nerve entrapment is a rare cause of pelvic pain that can be associated with lower urinary tract symptoms (LUTS). The LUTS incidence among PNE patients and the urodynamic study (UDS) role are underexplored. This study aims to explore the role of the UDS in PNE diagnosis and describe the prevalence of LUTS in this population.

Material and methods:

This retrospective, multicentric, cross-sectional study analyzed 144 patients with suspected PNE syndrome between 2016 and 2024. Electronic medical urology records of chronic pelvic pain patients were evaluated. The diagnosis of PNE was established based on neurophysiological tests (NFS) and response to pudendal nerve block. Complaints of LUTS were recorded, and UDS was systematically performed as part of the diagnostic course. PNE patients with LUTS who underwent surgery were evaluated considering LUTS and pain improvement at 12 months postoperatively.

Results:

A total of 87 patients (60.4%) were diagnosed with PNE. Among them, 51% reported LUTS, with a similar prevalence in women (56%) and men (55%). A statistically significant difference was found between gender and UDS dysfunction ($p=0.013$), with underactive detrusor predominance in women (44%) and bladder outlet obstruction in men (40%). LUTS were more prevalent in patients with CPP from other causes, in both females ($p=0.027$) and males ($p=0.030$). UDS dysfunctions showed a statistically significant difference between PNE and other CPP causes only in females ($p=0.023$). Female PNE patients have more UDS anomalies in comparison to CPP from other causes. Of the PNE patients with LUTS, only 24 (60%) underwent surgery, and 11 (45.8%) experienced symptom improvement. In the univariate analysis, UDS results did not predict LUTS improvement after surgery ($p=0.680$).

Conclusion:

LUTS are highly prevalent in PNE and detectable in UDS. Assessing urinary symptoms is crucial in PNE evaluation. Urodynamic tests help clarify if LUTS stems from PNE or other CP causes. However, UDS findings do not predict LUTS improvement after surgery.