Pudendal nerve entrapment syndrome is an unusual cause of chronic pelvic pain. We experienced a case of pudendal neuralgia associated with a ganglion cyst. A 60-year-old male patient with a tingling sensation and burning pain in the right buttock and perineal area visited our outpatient rehabilitation center. Pelvis magnetic resonance imaging showed the presence of multiple ganglion cysts around the right ischial spine and sacrospinous ligament, and the pudendal nerve and vessel bundle were located between the ischial spine and ganglion cyst at the entrance of Alcock's canal. We aspirated the lesions under ultrasound guidance, and consequently his symptoms subsided during a 6-month follow-up. This is the first report of pudendal neuralgia caused by compression from a ganglion cyst around the sacrospinous ligament.
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To evaluate the effect of semiconditional electrical stimulation of the pudendal nerve afferents for the neurogenic detrusor overactivity in patients with spinal cord injury. Forty patients (36 males, 4 males) with spinal cord injury who had urinary incontinence and frequency, as well as felt bladder contraction with bladder filling sense or autonomic dysreflexic symptom participated in this study.
Patients with neurogenic detrusor overactivity were subdivided into complete injury and incomplete injury groups by ASIA classification and subdivided into tetraplegia and paraplegia groups by neurologic level of injury. Bladder function, such as bladder volumes infused to the bladder until the first occurrence of neurogenic detrusor overactivity (Vini) and the last contraction suppressed by electrical stimulation (Vmax) was measured by water cystometry (CMG) and compared with the results of each subgroup.
Among the 40 subjects, 35 patients showed neurogenic detrusor overactivity in the CMG study. Among these 35 patients, detrusor overactivity was suppressed effectively by pudendal nerve afferent electrical stimulation in 32 patients. The infusion volume until the occurrence of the first reflex contraction (Vini) was 99.4±80.3 ml. The volume of saline infused to the bladder until the last contraction suppressed by semiconditional pudendal nerve stimulation (Vmax) was 274.3±93.2 ml, which was significantly greater than Vini. In patients with good response to the pudendal nerve afferent stimulation, the bladder volume significantly increased by stimulation in all the patients.
In this study, semiconditional electrical stimulation on the dorsal penile afferent nerve could effectively inhibit neurogenic detrusor overactivity and increase bladder volume in patients with spinal cord injury.
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This study was designed to evaluate the usefulness of pudendal nerve block in the dorsal approach under EMG monitoring. The patient is placed in the prone position. The location of pudendal nerve is identified using the both ischial tuberosities and greater trochanter. We have performed the pudenal nerve block with 5% phenol solution, under the EMG monitoring. The patient was able to void with percussion method. There has been no impairment in urinary continence.
We experienced an excellent effect of bilateral pudendal nerve block in the dorsal approach, under EMG montoring, using 5% phenol solution in detrusor sphincter dyssynergia of neurogenic bladder.
Objective: To examine the nerve supply of external anal sphinctor muscle which contributes for the anal or urinary continence.
Method: In the present study, sacral arc reflex was examined by an electrical stimulation of the penile shaft and recording of the compound muscle action potential from the external anal sphincter muscle with surface electrode, and pudendal nerve conduction was done by using a magnetic stimulation of proximal and distal cauda equina and recording from the external anal sphincter muscle.
Results: The results showed that the mean sacral arc reflex latency was 36.88⁑3.59 msec, and mean amplitude was 223⁑51.86 ㄍV with an electrical stimualtion. The mean latency by a magnetic stimulation of the proximal cauda equina was 6.34⁑1.29 msec, and the mean amplitude was 138⁑56 ㄍV. The mean latency by a magnetic stimualtion of the distal cauda equina was 3.67⁑0.44 msec, mean amplitude was 534⁑380 ㄍV.
Conclusion: The pudendal nerve conduction study using a magnetic stimulation is a useful evaluation tool for the fecal incontinence of peripheral type, and neurogenic bladder.
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