AI Summary & Key Takeaways
AI InsightSurgical intervention may provide a significant improvement in clinical andfunctional status.
📌 3 Key Takeaways
Özet
Pudendal syndrome is primarily characterized by stress urinary incontinence, dysuria, sexual arousal syndrome, painfulerections, and anal incontinence. The syndrome occurs when the pudendal nerve or one of its branches is compressed,stretched, or injured. Double crush is the compression of a peripheral nerve at two or more separate areas with various signsand symptoms. We, herein, aimed to introduce the case of a 42-year-old male who underwent the distal release procedure due tothe diagnosis of “double crush pudendal syndrome” following a proximal release surgery previously performed elsewhere. Thepatient's history revealed a pelvic fracture with urethral injury 27 years ago. Throughout the years, the patient had beenevaluated by various medical disciplines and undergone several treatments. In 2017, an orthopedic surgeon performedproximal pudendal nerve release using transgluteal approach, and then rectal pain and defecation complaints relieved.However, in 2019, the patient was referred to our clinic because of the persistence of erection and perineal complaints afterthe proximal pudendal nerve release. Based on a detailed clinical and laboratory assessment, the diagnosis of double crushneuropathy was established, and distal release of the pudendal nerve using transperineal approach was performed. To determinethe efficiency of the surgical treatment, International Index of Erectile Function (IIEF) and Quality of Erection Questionnaire(QAQ) tests were used preoperatively and at the first postoperative year. Furthermore, to assess the perineal pain, erection pain,and pain during intercourse Visual Analog Scale (VAS) was used. The erectile dysfunction improved from the severe degree (9points) to the mild degree (22 points) postoperatively. The patient’s general and sexual satisfaction scores, and erection qualityscore improved compared to the preoperative baseline. According to VAS, the perineal pain, erectile pain,and pain duringintercourse decreased postoperatively. (from 7 to 2 out of 10, from 8 to 3 out of 10, from 7 to 2 out of 10, respectively). Whenperineal and sexual complaints are encountered following pelvic trauma, the pudendal nerve-related problems, especiallydouble crush syndrome, should be kept in mind in differential diagnosis. A multidisciplinary approach must be established inorder to avoid any delay in diagnosis and treatment. Surgical intervention may provide a significant improvement in clinical andfunctional status.