Impact of laparoscopic pudendal nerve decompression on quality of life in patients suffering from pudendal neuralgia caused by entrapment syndrome

Abstract

Background: Pudendal neuralgia caused by entrapment syndrome (PNE) is an underdiagnosed condition with severe quality of life (QoL) impact. In cases unresponsive to medical treatment, a minimally invasive surgical approach, such as laparoscopic surgery, is preferred, particularly in patients presenting central sensitisation (CS) and myofascial syndrome (MS). Although the procedure has proven to be safe and feasible, limited studies examinate its impact on QoL.

Objectives: This retrospective observational study was conducted at the Résilience Center, Axium Clinic, Aix-en-Provence, France, with the objective to assess QoL improvement and pain relief in PNE patients treated with laparoscopic pudendal neurolysis, focusing on those with CS. Secondary objectives included assessing the occurrence of surgical complications and improvements in urinary, intestinal and sexual functions.

Methods: The study involved 147 patients operated from January 2018 to June 2023. The patients' status was evaluated using validated surveys at the preoperative consultation, at 4-6 weeks, 6-12 months and 3 years post-surgery for those operated up to 2020.

Results: The laparoscopic approach resulted safe and effective, showing significant improvements in VAS score (χ2:132.4,df=3,p < 0.001), QoL (χ2:133,df=3,p < 0.001), urinary (χ2:26.3,df=3,p < 0.001), intestinal (χ2:26.3,df=3,p < 0.001), and sexual functions (χ2:8.5,df=3,p < 0.001). MS and CS patients demonstrated diminished improvement scores. The implementation of a multidisciplinary approach significantly improved outcomes within these subgroups. A preoperative VAS score >8 was a significant risk factor for surgical failure (OR 19.2 for PGI, 14.2 for QoL, p < 0.001).

Conclusion: A multidisciplinary approach aimed at reducing VAS score below 8 before surgery is recommended to optimize outcomes, particularly in CS patients.

Keywords: Central sensitization; Chronic pelvic pain; Laparoscopic nerve decompression; Nerve entrapment syndrome; Pudendal neuralgia; Quality of life.