A new cure for pudendal neuralgia: preliminary results

Background Pudendal neuralgia is an increasing multifactorial condition, involving severe and chronic pain along the course of pudendal nerve, with heavy impact on patient’s quality of life. Current therapies include multianalgesic therapy, nerve blocks, surgery and neuromodulation, with controversial results, particu- larly in the long-term period, and possible side effects. With the aim of successfully treating pudendal neuralgia, avoiding a surgical decompression and the side effects of medical therapy we did a new operation, consisting of transperineal injection of adipose tis- sue with staminal cells in the Alcock’s channel. Methods Fifteen women with pudendal neuralgia not responsive to 3 monthsmedical therapy were examined clinically, with VAS score, vali- dated SF-36 Health Survey questionnaire, and pudendal nerve motor terminal latency (PNMTL). All patients were operated on by multiple transperineal injections of autologous adipose tissue with staminal cells, using the Coleman’s lipostructure technique. Clinical examinations with VAS, SF36 and PNMTL were scheduled during 12 months follow-up, with the incidence of pain recurrence (VAS [ 5) as primary outcome measure. Appropriate tests were used for statistics. Results All patients had preoperative signs of pudendal neuropathy with increase of nerve latency. Twelve patients completed the follow up protocol. There was no mortality and no complications. Two patients had no pain improvement and continued to use analgesic drugs. At 12 months VAS significantly improved (3.2 ± 0.9 vs 8.1 ± 1.2 preoperative, P \ 0.001) as well as SF36 (75.5, with range 71–80, vs 85, with range 82–89, pre- operative, P \ 0.01), while PNMTL showed a not significant trend to a better nerve conduction (2.4 ± 0.04 vs 2.5 ± 0.03 preopera- tive, P = NS). Conclusions The new technique is easy and complication-free, with significant improvement of symptoms in the short period. A larger study with appropriate controls and longer follow-up is now needed to assess its real effectiveness. Reasons for the gap between clinical and functional results need further study.