Пудендальная невралгия
https://doi.org/10.17650/2222-8721-2023-13-4-83-96
Аннотация
Пудендальная невралгия является наиболее часто встречающимся типом нейрогенной хронической тазовой боли и определяется как хронический нейропатический болевой синдром, обусловленный компрессией и/или нейропатией полового нерва и локализующийся в зоне его сенсорной иннервации. Пудендальная невралгия негативно влияет на повседневную активность и снижает качество жизни. Диагноз пудендальной невралгии устанавливается на основании клинических проявлений и данных осмотра в соответствии с Нантскими критериями, при этом инструментальные методы (ультразвуковое исследование, магнитно-резонансная и компьютерная томография, методы электродиагностики) не позволяют верифицировать диагноз в связи со значительными ограничениями. В настоящее время не существует однозначных рекомендаций и стандартов по лечению пудендальной невралгии, однако комбинация разных методов и персонализированный подход позволяют в ряде случаев достичь значительного успеха и продолжительного контроля болевого синдрома. В статье подробно освещены анатомические особенности пудендального нерва, рассмотрены возможности и этапы диагностики пудендальной невралгии, представлен обзор лечебных методов с позиций доказательной медицины.
Об авторах
И. В. Бородулина
ФГБОУ ДПО «Российская медицинская академия непрерывного последипломного образования» Минздрава России
Россия
Россия
125993 Москва, ул. Баррикадная, 2/1, стр. 1
Г. В. Ковалев
Клиника высоких медицинских технологий ФГБОУ ВО «Санкт-Петербургский государственный университет»
Россия
Россия
190103 Санкт-Петербург, набережная реки Фонтанки, 154
Список литературы
1. Leslie S.W., Antolak S., Feloney M.P., Soon-Sutton T.L. Pudendal Neuralgia. In: StatPearls. Treasure Island: StatPearls Publishing, 2022.
2. Kaur J., Leslie S.W., Singh P. Pudendal Nerve Entrapment Syndrome. In: StatPearls. Treasure Island: StatPearls Publishing, 2023.
3. Engeler D., Baranowski A.P., Berghmans B. et al. EAU Guidelines on Chronic Pelvic Pain. 2022. European Association of Urology.
4. Shoskes D.A., Nickel J.C., Dolinga R., Prots D. Clinical phenotyping of patients with chronic prostatitis/chronic pelvic pain syndrome and correlation with symptom severity. Urology 2009;73(3):538–42; discussion 542–3. DOI: 10.1016/j.urology.2008.09.074
5. Magri V., Wagenlehner F., Perletti G. et al. Use of the UPOINT chronic prostatitis/chronic pelvic pain syndrome classification in European patient cohorts: sexual function domain improves correlations. J Urol 2010;184(6):2339–45. DOI: 10.1016/j.juro.2010.08.025
6. Häuser W., Baranowski A., Messelink B., Wesselmann U. Taxonomies for chronic visceral pain. Pain 2020;161(6):1129–35. DOI: 10.1097/j.pain.0000000000001825
7. Hibner M., Desai N., Robertson L.J., Nour M. Pudendal neuralgia. J Minim Invasive Gynecol 2011;17(2):148–53. DOI: 10.1016/j.jmig.2009.11.003
8. Shafik A., el-Sherif M., Youssef A., Olfat E.S. Surgical anatomy of the pudendal nerve and its clinical implications. Clin Anat 1995;8(2):110–5. DOI: 10.1002/ca.980080205.
9. Bautrant E., de Bisschop E., Vaini-Elies V. et al. Modern algorithm for treating pudendal neuralgia: 212 cases and 104 decompressions. J Gynecol Obstet Biol Reprod 2003;32(8 Pt 1):705–12.
10. Oelhafen K., Shayota B.J., Muhleman M. et al. Benjamin Alcock (1801–?) and his canal. Clin Anat 2013;26(6):662–6. DOI: 10.1002/ca.22080
11. Juenemann K.P., Lue T.F., Schmidt R.A., Tanagho E.A. Clinical significance of sacral and pudendal nerve anatomy. J Urol 1988;139:74–7. DOI: 10.1016/s0022-5347(17)42297-x
12. Schmidt R.A. Technique of pudendal nerve localization for block or stimulation. J Urol 1989;142:1528–31. DOI: 10.1016/s0022-5347(17)39150-4
13. Крылов Г.А. Этимологический словарь русского языка. М.: Виктория плюс, 2017. 432 с.
14. Kinter K.J., Newton B.W. Anatomy, Abdomen and Pelvis, Pudendal Nerve. In: StatPearls. Treasure Island: StatPearls Publishing, 2023.
15. Everaert K., de Waard W., Van Hoof T. et al. Neuroanatomy and neurophysiology related to sexual dysfunction in male neurogenic patients with lesions to the spinal cord or peripheral nerves. Spinal Cord 2010;48(3):182–91. DOI: 10.1038/sc.2009.172
16. Claes H., Bijnens B., Baert L. The hemodynamic influence of the ischiocavernosus muscles on erectile function. J Urol 1996;156(3):986–90.
17. Ghanavatian S., Leslie S.W., Derian A.. Pudendal Nerve Block. In: StatPearls. Treasure Island: StatPearls Publishing, 2023.
18. Weech D., Ameer M.A., Ashurst J.V. Anatomy, Abdomen and Pelvis, Penis Dorsal Nerve. In: StatPearls. Treasure Island: StatPearls Publishing, 2023.
19. Tajkarimi K., Burnett A.L. The role of genital nerve afferents in the physiology of the sexual response and pelvic floor function. J Sex Med 2011;8(5):1299–312. DOI: 10.1111/j.1743-6109.2011.02211.x
20. Gillitzer R., Hampel C., Wiesner C. et al. Pudendal nerve branch injury during radical perineal prostatectomy. Urology 2006;67(2): 423.e1–423.e3. DOI: 10.1016/j.urology.2005.08.012
21. Sultan A.H., Kamm M.A., Hudson C.N. Pudendal nerve damage during labour: prospective study before and after childbirth. Br J Obstet Gynaecol 1994;101(1):22–8. DOI: 10.1111/j.1471-0528.1994.tb13005.x
22. Snooks S.J., Swash M., Henry M.M., Setchell M. Risk factors in childbirth causing damage to the pelvic floor innervation. Int J Colorectal Dis 1986;1(1):20–4. DOI: 10.1007/BF01648831
23. Pailhé R., Chiron P., Reina N. et al. Pudendal nerve neuralgia after hip arthroscopy: retrospective study and literature review. Orthop Traumatol Surg Res 2013;99(7):785–90. DOI: 10.1016/j.otsr.2013.07.015
24. Elahi F., Callahan D., Greenlee J., Dann T.L. Pudendal entrapment neuropathy: a rare complication of pelvic radiation therapy. Pain Physician 2013;16(6):E793–7.
25. Howard E.J. Postherpetic pudendal neuralgia. JAMA 1985;253(15): 2196.
26. Pourfridoni M., Pajokh M., Seyedi F. Bladder and bowel incontinence in COVID-19. J Med Virol 2021;93(5):2609–10. DOI: 10.1002/jmv.26849
27. Lee J.W., Lee S.M., Lee D.G. Pudendal nerve entrapment syndrome due to a ganglion cyst: A case report. Ann Rehabil Med 2016;40(4):741–4. DOI: 10.5535/arm.2016.40.4.741
28. Kim Y.J., Kim D.H. Pudendal nerve entrapment syndrome caused by ganglion cysts along the pudendal nerve. Yeungnam Univ J Med 2021;38(2):148–51. DOI: 10.12701/yujm.2020.00437
29. Engeler D., Baranowski D., Borovicka A. et al. EAU Guidelines. Chronic Pelvic Pain Pocket Guidelines. 2018. European Association of Urology.
30. Labat J.J., Riant T., Robert R. et al. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn 2008;27(4):306–10. DOI: 10.1002/nau.20505
31. Ilyashenko V. Pudendal neuralgia: diagnostics and treatment. Pain Med 2019;3:54–7. DOI: 10.31636/pmjua.v3i4.3
32. Wadhwa V., Hamid A.S., Kumar Y. et al. Pudendal nerve and branch neuropathy: magnetic resonance neurography evaluation. Acta Radiol 2017;58(6):726–33. DOI: 10.1177/0284185116668213
33. Ly J., Scott K., Xi Y. et al. Role of 3 Tesla MR neurography and CT-guided injections for pudendal neuralgia: Analysis of pain response. Pain Physician 2019;22(4):E333–E344.
34. Tagliafico A., Bignotti B., Miguel Perez M. et al. Contribution of ultrasound in the assessment of patients with suspect idiopathic pudendal nerve disease. Clin Neurophysiol 2014;125(6):1278–84. DOI: 10.1016/j.clinph.2013.10.053
35. Tagliafico A., Perez M.M., Martinoli C. High-Resolution ultrasound of the pudendal nerve: normal anatomy. Muscle Nerve 2013;47(3):403–8. DOI: 10.1002/mus.23537.
36. Lefaucheur J.P., Labat J.J., Amarenco G. et al. What is the place of electroneuromyographic studies in the diagnosis and management of pudendal neuralgia related to entrapment syndrome? Clin Neurophysiol 2007;37(4):223–8. DOI: 10.1016/j.neucli.2007.07.004
37. Siroky M.B. Electromyography of the perineal floor. Urol Clin North Am 1996;23:299–307. DOI: 10.1016/s0094-0143(05)70312-8
38. Campbell J.N., Meyer R.A. Mechanisms of neuropathic pain. Neuron 2006;52:77–92. DOI: 10.1016/j.neuron.2006.09.021
39. Longstaff L., Milner R.H., O’Sullivan S., Fawcett P. Carpal tunnel syndrome: the correlation between outcome, symptoms and nerve conduction study findings. J Hand Surg 2001;26:475–80. DOI: 10.1054/jhsb.2001.0616
40. Delodovici M.L., Fowler C.J. Clinical value of the pudendal somatosensory evoked potential. Electroencephalogr Clin Neurophysiol 1995;96(6):509–15. DOI: 10.1016/0013-4694(95)00081-9
41. Örmeci B., Avci E., Kaspar Ç. et al. A novel electrophysiological method in the diagnosis of pudendal neuropathy: Position-related changes in pudendal sensory evoked potentials. Urology 2017;99:288.e1–288.e7. DOI: 10.1016/j.urology.2016.09.040
42. Levesque A., Bautrant E., Quistrebert V. et al. Recommendations on the management of pudendal nerve entrapment syndrome: A formalised expert consensus. Eur J Pain 2022;26(1):7–17. DOI: 10.1002/ejp.1861
43. Montenegro M.L., Mateus-Vasconcelos E.C., Candido dos Reis F.J. et al. Thiele massage as a therapeutic option for women with chronic pelvic pain caused by tenderness of pelvic floor muscles. J Eval Clin Pract 2010;16(5):981–2. DOI: 10.1111/j.1365-2753.2009.01202.x.
44. Silva A.P., Montenegro M.L., Gurian M.B. et al. Perineal massage improves the dyspareunia caused by tenderness of the pelvic floor muscles. Rev Bras Ginecol Obstet 2017;39(1):26–30. DOI: 10.1055/s-0036-1597651.
45. Sikiru L., Shmaila H., Muhammed S.A. Transcutaneous electrical nerve stimulation (TENS) in the symptomatic management of chronic prostatitis/chronic pelvic pain syndrome: a placebo-control randomized trial. Int Braz J Urol 2008;34(6):708–13; discussion 714. DOI: 10.1590/s1677-55382008000600005
46. Sato T., Nagai H. Sacral magnetic stimulation for pain relief from pudendal neuralgia and sciatica. Dis Colon Rectum 2002;45(2):280–2. DOI: 10.1007/s10350-004-6162-8
47. Hodaj H., Payen J.F., Hodaj E. et al. Long-term treatment of chronic orofacial, pudendal, and central neuropathic limb pain with repetitive transcranial magnetic stimulation of the motor cortex. Clin Neurophysiol 2020;131(7):1423–32. DOI: 10.1016/j.clinph.2020.03.022
48. Rayner L., Hotopf M., Petkova H. et al. Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs. Pain 2016;157(7):1472–9. DOI: 10.1097/j.pain.0000000000000542
49. Рачин С.А., Шаров М.Н., Зайцев А.В. и др. Хроническая тазо- вая боль: от правильной диагностики к адекватной терапии. Неврология, нейропсихиатрия, психосоматика 2020;12(2):12–6. DOI: 10.14412/2074-2711-2020-2-12-16
50. Mamlouk M.D., van Sonnenberg E., Dehkharghani S. CT-guided nerve block for pudendal neuralgia: diagnostic and therapeutic implications. AJR Am J Roentgenol 2014;203(1):196–200. DOI: 10.2214/AJR.13.11346
51. Bendtsen T.F., Parras T., Moriggl B. et al. Ultrasound-guided pudendal nerve block at the entrance of the pudendal (Alcock) canal: description of anatomy and clinical technique. Reg Anesth Pain Med 2016;41(2):140–5. DOI: 10.1097/AAP.0000000000000355.
52. Labat J.J., Riant T., Lassaux A. et al. Adding corticosteroids to the pudendal nerve block for pudendal neuralgia: A randomised, double-blind, controlled trial. BJOG 2017;124(2):251–60. DOI: 10.1111/1471-0528.14222
53. Cok O.Y., Eker H.E., Cok T. et al. Transsacral S2-S4 nerve block for vaginal pain due to pudendal neuralgia. J Minim Invasive Gynecol 2011;18(3):401–4. DOI: 10.1016/j.jmig.2011.02.007
54. Filippiadis D.K., Velonakis G., Mazioti A. et al. CT-guided percutaneous infiltration for the treatment of Alcock's neuralgia. Pain Physician 2011;14(2):211–5.
55. Ricci P., Wash A. Pudendal nerve block by transgluteal way guided by computed tomography in a woman with refractory pudendal neuralgia expressed like chronic perineal and pelvic pain. Arch Esp Urol 2014;67(6):565–71.
56. Krijnen E.A., Schweitzer K.J., van Wijck A.J.M., Withagen M.I.J. Pulsed radiofrequency of pudendal nerve for treatment in patients with pudendal neuralgia. A case series with long-term follow-up. Pain Pract 2021;21(6):703–7. DOI: 10.1111/papr.12999
57. Ozkan D., Akkaya T., Yildiz S., Comert A. Ultrasound-guided pulsed radiofrequency treatment of the pudendal nerve in chronic pelvic pain. Anaesthesist 2016;65(2):134–6. DOI: 10.1007/s00101-015-0133-4
58. Zhu D., Fan Z., Cheng F. et al. The efficacy of an ultrasoundguided improved puncture path technique of nerve block/pulsed radiofrequency for pudendal neuralgia: A retrospective study. Brain Sci 2022;12(4):510. DOI: 10.3390/brainsci12040510
59. Fang H., Zhang J., Yang Y. et al. Clinical effect and safety of pulsed radiofrequency treatment for pudendal neuralgia: a prospective, randomized controlled clinical trial. J Pain Res 2018;11:2367–74. DOI: 10.2147/JPR.S167866
60. Guo K.K., Wang L., Liu F. et al. Sacral nerve stimulation in patients with refractory pudendal neuralgia. Pain Physician 2022;25(4):619–27.
61. Valovska A., Peccora C.D., Philip C.N. et al. Sacral neuromodulation as a treatment for pudendal neuralgia. Pain Physician 2014;17(5):645–50.
62. Peters K.M., Killinger K.A., Jaeger C., Chen C. Pilot study exploring chronic pudendal neuromodulation as a treatment option for pain associated with pudendal neuralgia. Low Urin Tract Symptoms 2015;7(3):138–42. DOI: 10.1111/luts.12066
63. Waxweiler C., Dobos S., Thill V., Bruyninx L. Selection criteria for surgical treatment of pudendal neuralgia. Neurourol Urodyn 2017;36(3). DOI: 10.1002/nau.22988
64. Shafik A., El Sibai O., Shafik I.A., Shafik A.A. Role of sacral ligament clamp in the pudendal neuropathy (pudendal canal syndrome): Results of clamp release. Int Surg 2007;92(1):54–9.
65. Robert R., Labat J.J., Bensignor M. et al. Decompression and transposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation. Eur Urol 2005;47(3):403–8. DOI: 10.1016/j.eururo.2004.09.003
66. Buffenoir K., Rioult B., Hamel O et al. Spinal cord stimulation of the conus medullaris for refractory pudendal neuralgia: A prospective study of 27 consecutive cases. Neurourol Urodyn 2015;34(2):177–82. DOI: 10.1002/nau.22525.
67. Hibner M., Castellanos M.E., Drachman D., Balducci J. Repeat operation for treatment of persistent pudendal nerve entrapment after pudendal neurolysis. J Minim Invasive Gynecol 2012;19(3):325–30. DOI: 10.1016/j.jmig.2011.12.022
68. Luesma M.J., Galé I., Fernando J. Diagnostic and therapeutic algorithm for pudendal nerve entrapment syndrome. Med Clin (Barc) 2021;157(2):71–8. DOI: 10.1016/j.medcli.2021.02.012
69. Pérez-López F.R., Hita-Contreras F. Management of pudendal neuralgia. Climacteric 2014;17(6):654–6. DOI: 10.3109/13697137.2014.912263
70. Filler A.G. Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery. Neurosurg Focus 2009;26(2):E9. DOI: 10.3171/FOC.2009.26.2.E9
71. Orpha.Net. Avaialble at: https://www.orpha.net/.
72. Rare Disease InfoHub. Available at: https://rarediseases.oscar.ncsu.edu/.
73. Перечень редких (орфанных) заболеваний. Доступно по: https://minzdrav.gov.ru/documents/9641-perechen-redkih-orfannyh-zabolevaniy.
74. Извозчиков С.Б. Механизмы формирования и диагностика туннельных пудендонейропатий. Журнал неврологии и психиатрии им. С.С. Корсакова. 2019;119(11):98–102. DOI: 10.17116/jnevro201911911198
75. Кузьменкова Л.Н., Чагава Д.А., Древаль О.Н. и др. Современные принципы хирургического лечения нейропатии полового нерва (обзор). Саратовский научно-медицинский журнал 2022;18(4):557–61.
Рецензия
Для цитирования:
Бородулина И.В., Ковалев Г.В. Пудендальная невралгия. Нервно-мышечные болезни. 2023;13(4):83‑96. https://doi.org/10.17650/2222-8721-2023-13-4-83-96
For citation:
Borodulina I.V., Kovalev G.V. Pudendal neuralgia. Neuromuscular Diseases. 2023;13(4):83‑96. (In Russ.) https://doi.org/10.17650/2222-8721-2023-13-4-83-96
Просмотров:
971
Послать статью по эл. почте 