Hibner Subset Slides Flashcards
Pudendal Neuralgia
Pain caused by injury to the pudendal nerve
Where is the pain for females in pudendal neuralgia?
Perineum, rectum, vulva, vagina, and clitoris
Where is the pain for males in pudendal neuralgia?
Perineum, rectum, penis, scrotum (not testicles)
Describe the anatomy of the pudendal nerve.
- Originates in S2-S4
- Exits the pelvis through the greater sciatic foramen
- Wraps around sacrospinous ligament
- Enters the perineal region.
- Provides motor, sensory, and autonomic innervation to pelvic organs, pelvic floor muscles, and external genitalia.
Describe the feelings associated with neuropathic pain.
Burning
Paresthesia
Allodynia
Hyperesthesia
What is the most common cause of PNE?
Injury to the pudendal nerve.
What causes the entrapment could be idiopathic, traumatic, or iatrogenic.
When does pain with pudendal neuralgia usually occur?
When sitting down, progressively getting worse, and worsening during the day.
What are some medications pudendlal neuaralgia has some responin to?
Antiseizure medications (neurontin, lyrica) Antidepressants (amitryptiline0
What is the average time it takes to make adiagnosis?
4 years.
Describe some therapies for PNE.
Behavioral changes
Conserative therapy.
Surgery.
What are some medical treatments for pudendal nerve disease?
Gabapentin
Amitryptiline
Pregabaline.
What does of pregabaline do you want to start the paitnet on?
75mg
When is surgery offered?
When a patient in whom physical examination ruled out other causes neuropathy.
Describe the age group that surgery has better improvemnt and explain why.
Young patients typically have better results from surgery. This could be due to a shorter period of compression.
Describe the postop management for pudendal surgery.
About 1 day of hospital stay.
No restrictions
Continue gabapentin 3200mg/day or Lyrica up to 600mg/day
If no improvement you can do CT guided injection after 4 months.
