Pudendal nerve release by robotic surgery

What exactly is the pudendal nerve and what is its function?

The pudendal nerve originates from the junction of 3 sacral vertebral roots, has a long course along the pelvis and divides into 3 branches that reach the rectum to the perineum and genitals. It is responsible for the sensations and function of most of the pelvic organs (rectum, bladder, prostate, perineum, vagina, genitals…).

What happens if the pudendal nerve is trapped?

If the nerve becomes entrapped, Pudendal Nerve Entrapment Syndrome (PNAS) occurs.

PNDS was first described in 1987 by Dr. Amerenco, a neurologist, who was studying a cyclist patient with chronic pelvic pain. It is characterized by:

  • Significantly affecting quality of life, being highly disabling.
  • It affects both women and men.
  • Being very frequent and yet it is very little known.
  • This leads to a delay in its diagnosis. It is considered that, from the moment the patient starts the symptoms until a correct diagnosis is made, an average of 5 years goes by, during which he/she consults many specialists and even undergoes multiple studies and even unnecessary surgeries.

How does pudendal nerve entrapment manifest itself?

The symptoms vary from one patient to another and depend on whether there is complete entrapment or only of some of its branches, the degree of compression, the time of evolution…

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Pain is the predominant symptom and is present in most patients. Pain manifests itself in different forms: burning, stinging, itching, cramps… and at different intensities: from discomfort to very intense pain that has little response to analgesics.

In addition to pain, other symptoms appear such as:

  • In the bladder: frequency of urination, urgency, burning, stinging. Similar to cystitis.
  • Rectum: sensation of anal occupation, burning, itching, stinging.
  • Sexual: pain during or after sexual intercourse, impotence or painful ejaculation in men.

Symptoms are usually less intense in the morning and improve at bedtime, while they worsen when sitting and towards the end of the day.

How is pudendal nerve release performed by robotic surgery?

The goal of the surgery is to release or decompress the nerve so that symptom relief can occur. This is accomplished by sectioning a ligament (sacrospinous) and opening the alcock canal. It requires meticulous and precise surgery.

In any type of peripheral nerve release surgery, precision will be essential to minimize the risk of damage that may occur during the intervention. Thus, the precision provided by robotic surgery makes it the best possible treatment for nerve release. Today, thanks to its quality of vision and precision, the Da Vinci robot is the best surgical tool for this pathology.

Thus, this minimally invasive surgical procedure is performed using a very sophisticated robotic system controlled by the surgeon. In this case, the specialist uses controls, seated at a console just a few meters away from the patient. The robot replicates the movements of the surgeon’s hand, with very delicate movements and very precise surgical tools.

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How are the results after surgery? What is the postoperative period like?

The postoperative period is quick and comfortable with a hospital stay of 24 hours.

The robotic approach is the approach of first choice because of its precision and less aggressiveness. In general the success rate is around 60-70%.

It is advisable to inform patients of the possibility of a rebound effect with increased pain in the first months after surgery. It is advisable to evaluate results from the 6th month after surgery. During this period of time pain control with analgesia and physiotherapy to resolve trigger points associated with myofascial syndrome are advisable to improve patient comfort.

For more information, please consult a specialist in Urology.