Background & Aims
Chronic pelvic pain (CPP) is a common, complex, and multifactorial condition, poorly understood, with a significant impact on quality of life.
Chronic neuropathic pelvic pain can be caused by a nervous system lesion or disease.
Electrodiagnostic tests (EDX) are fundamental for neurogenic chronic pelvic pain due to peripheral neuropathy defining the localization, pathophysiology, chronicity, severity, and prognosis.
This single-center, retrospective study aimed to identify predictive factors in neurophysiological testing that may inform therapeutic strategies for CPP management.
Methods
A total of 69 adult patients with CPP were analyzed, 25 female, 44 male, mean age 37,54, between January 2022 and December 2023.
EDX tests including electromyography (EMG) of pelvic floor muscles, nerve conduction studies (ENG) pudendal nerve terminal motor latency (PNTML), somatosensory evoked potentials (SEPs) of pudendal and posterior tibial nerves, sympathetic skin response (SSR) of the perineal area and sacral reflex – bulbocavernosus reflex (BCR), were performed to assess pudendal nerves function, and pelvic floor muscle activity.
Data from medical history, demographics, neurophysiological test results, and treatment outcomes were collected and analyzed.
Results
Of the 69 patients, 74% presented with unilateral pudendal neuropathy.
EDX found abnormalities in 62% of patients, including abnormal Pudendal SEPs (56%), delayed PNTML (78,3%), and abnormal sacral reflexes (53%).
Statistical analyses were performed to identify predictive factors associated with poor therapeutic outcomes, with particular attention on the severity of pudendal neuropathy, especially for unilateral presentation.
Conclusions
This retrospective study emphasizes the importance of EDX testing in clarifying the pathophysiology of chronic neurogenic pelvic pain and in identifying predictive factors that allow addressing therapeutic strategies for CPP management.
Severe unilateral pudendal neuropathy associated with delayed sacral reflexes and significant alteration of Pudendal SEPs were linked with poor therapeutic outcomes.
A comprehensive assessment of neural activity of the pelvic and perineal area, including neurophysiological testing is necessary for early identification and targeted interventions for individualized management, allowing for the optimization of therapeutic outcomes and improving patient care.
References
EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2023. ISBN 978-94-92671-19-6.
Labat, J.J., et al. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn, 2008. 27: 306.
Amarenco, G., et al. Electrophysiological analysis of pudendal neuropathy following traction. Muscle Nerve, 2001. 24: 116.
Labat, J.J., et al. [Electrophysiological studies of chronic pelvic and perineal pain]. Prog Urol, 2010. 20: 905.
Lee, J.C., et al. Neurophysiologic testing in chronic pelvic pain syndrome: a pilot study. Urology, 2001. 58: 246.
Lefaucheur, J.P., et al. What is the place of electroneuromyographic studies in the diagnosis and management of pudendal neuralgia related to entrapment syndrome? Neurophysiol Clin, 2007. 37: 223.