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Surgical Decompression of Pudendal Nerve by Transperineal Approach Using a Balloon Probe
American Journal of Medicine and Medical Sciences , 2012, DOI: 10.5923/j.ajmms.20120204.05
Abstract: Since 2009 may to 31 january 2012, 512 patients (371 females, 141 males) have benefited from a pudendal nerve (PN) decompression by transperineal approach using a ballon probe. These patients had clinical symptoms of pudendal neuralgia. Neurophysiological tests based on the staged sacral reflexes, on ultrasound investigations of pudendal vessels and on a pelvic floor ultrasounds evoked a zone of compressive hyperpressure at the level of the axis infrapiriformis area-ischiorectal fossa. All of these 512 patients, injection block at the level of the infrapiriformis area appeared positive between 1 to 9 months. Patients were known for this pathology since many years. Among these 512 patients, 66 had already PN decompression, 27 by transgluteal approach, 36 by transvaginal (♀)/transischiorectal (♂) approach and 3 by transperineal approach (Shakik extended) but without clinical efficiency.All of these 512 patients, surgical decompression was done by transperineal approach using a balloon probe.Surgical methodology, post-op follow up and results are reported hereby, which appear quite successful with few risks to make worse the pathology and no risk on pelvic static.
CT Guided Pudendal Nerve Block  [PDF]
Howard M. Richard III, Richard P. Marvel
Open Journal of Radiology (OJRad) , 2013, DOI: 10.4236/ojrad.2013.31006

Purpose: Retrospective review of CT-guided pudendal nerve blockade for chronic pelvic pain caused by pudendal neuralgia. Materials & Methods: The study included 23 patients (average age, 40.6 yr; range, 25 - 71 yr) diagnosed with pudendal neuralgia. Diagnostic criteria were: pain in the anatomic distribution of the pudendal nerve, pain worsening with sitting, pain relieved by lying down, and no sensory loss on examination. Alternative etiologies were considered and, if present, patients were excluded from the study. Patients underwent 1 - 4 CT-guided pudendal nerve blocks, using 22-gauge spinal needles placed with intermittent CT guidance. The needles were directed to the expected path of the pudendal nerve, either immediately caudal to the ischial spine or in Adcock’s canal. Nerve blocks were performed with 1 cc depot methylprednisolone (40 mg/cc), Bupivacaine 0.25% (3 cc) and Lidocaine 2% (2 cc). Procedure times were recorded. Patients were examined for perineal and vulva anesthesia 1 h after the blocks were performed. Patients records were reviewed for procedural success and complications. Results: Procedure time was 17.1 min (range, 11 - 26). Twenty-one blocks were performed at the ischial spine, and 2 were performed at the pudendal canal. Twenty-two (95.6%) of 23 patients reported perineal analgesia after the injection was performed, for a procedural success rate of 96%. One patient developed bilateral leg weakness which resolved in 6. Conclusion: Pudendal nerve block can be performed with CT guidance in a safe and effective manner. Further evaluation of the long-term effectiveness of the procedure with a prospective study is warranted.

Pudendal nerve decompression in perineology : a case series
Jacques Beco, Daniela Climov, Michèle Bex
BMC Surgery , 2004, DOI: 10.1186/1471-2482-4-15
Abstract: In this retrospective analysis, the studied sample comprised 74 female patients who underwent a bilateral PND between 1995 and 2002. To accomplish the first aim, the patients sample was compared before and at least one year after surgery by means of descriptive statistics and hypothesis testing. The second aim was achieved by means of a statistical comparison between the patient's group before the operation and a control group of 82 women without any of the following signs: prolapse, anal incontinence, perineodynia, dyschesia and history of pelvi-perineal surgery.When bilateral PND was the only procedure done to treat the symptoms, the cure rates of perineodynia, anal incontinence and urinary incontinence were 8/14, 4/5 and 3/5, respectively. The frequency of the three clinical signs was significantly reduced. There was a significant reduction of anal and perineal PNTML and a significant increase of anal richness on EMG. The Odd Ratio of the three clinical signs in the diagnosis of PCS was 16,97 (95% CI = 4,68 – 61,51).This study suggests that bilateral PND can treat perineodynia, anal and urinary incontinence. The three clinical signs of PCS seem to be efficient to suspect this diagnosis. There is a need for further studies to confirm these preliminary results.The objective of perineology is to treat each defect of the perineum with the right procedure [1-3]. Pudendal nerve decompression (PND) is theoretically a basic procedure in perineology thanks to its ability to treat the defect "pudendal neuropathy".Before going into details of this procedure, it is necessary to remember the anatomy of the pudendal nerve. This anatomy is still controversial.While summarizing the data of the literature and the results of our dissections, the likeliest anatomy of the pudendal nerve presents itself as follows. The pudendal nerve is a mixed nerve carrying motor and sensory fibers. Its fibers are derived from the sacral roots S2, S3 and S4 [4,5]. Once the roots traverse the sacral
Virtual Reflexes  [PDF]
Catholijn Jonker,Joost Broekens,Aske Plaat
Computer Science , 2014,
Abstract: Virtual Reality is used successfully to treat people for regular phobias. A new challenge is to develop Virtual Reality Exposure Training for social skills. Virtual actors in such systems have to show appropriate social behavior including emotions, gaze, and keeping distance. The behavior must be realistic and real-time. Current approaches consist of four steps: 1) trainee social signal detection, 2) cognitive-affective interpretation, 3) determination of the appropriate bodily responses, and 4) actuation. The "cognitive" detour of such approaches does not match the directness of human bodily reflexes and causes unrealistic responses and delay. Instead, we propose virtual reflexes as concurrent sensory-motor processes to control virtual actors. Here we present a virtual reflexes architecture, explain how emotion and cognitive modulation are embedded, detail its workings, and give an example description of an aggression training application.
Relief of Urinary Urgency, Hesitancy, and Male Pelvic Pain with Pulse Radiofrequency Ablation of the Pudendal Nerve: A Case Presentation  [PDF]
Christopher Bui,Sanjog Pangarkar,Scott I. Zeitlin
Case Reports in Urology , 2013, DOI: 10.1155/2013/125703
Abstract: Background and Aims. This report demonstrates the utility of a pudendal nerve block by pulsed radiofrequency ablation (RFA) for the treatment of male pelvic pain and urinary urgency and hesitancy. Methods. The patient is an 86-year-old gentleman with a 30-year history of urinary hesitancy and urgency. The patient also had pain in the area of the perineum but considered it a secondary issue. The patient was seen by a number of specialists, tried various medications, and underwent a variety of procedures to no avail. Therefore, the patient underwent a pulsed RFA of the pudendal nerve. Results. The patient underwent a pulsed RFA of the pudendal nerve; the patient reported marked improvement in his pelvic pain as well as a drastic reduction in his urinary urgency and hesitancy. Conclusion. Urinary urgency and hesitancy and male pelvic pain are some of the most common symptoms affecting men. Pudendal nerve block by pulsed RFA is an effective treatment of pelvic pain. It may also hold some therapeutic value in the treatment of urinary urgency and hesitancy as our case demonstrated. Further studies are needed to help clarify both the anatomy of the pelvis as well as if pudendal blocks are effective in treating more than pelvic pain. 1. Introduction This paper demonstrates the utility of a pudendal nerve block by pulsed radiofrequency ablation (RFA) for the treatment of male pelvic pain, urinary urgency and hesitancy. We describe the case of a man who presented with the above symptoms. The patient was seen by a number of specialists, tried various medications, and underwent a variety of procedures to no avail. However, after pulsed RFA of the pudendal nerve, the patient reported marked improvement in his pelvic pain as well as a drastic reduction in his urinary urgency and hesitancy. 2. Anatomy of the Pudendal Nerve The pudendal nerve originates in the sacral plexus from fibers of the second, third, and fourth anterior sacral rami (S2,3,4). The nerve follows a complex course and travels behind the sacrospinous ligament, medial to the ischial spine. The nerve exits the pelvis through the greater sciatic foramen and enters the ischiorectal fossa via the lesser sciatic foramen. After traveling through the pudendal canal (Alcock’s canal), it divides into its terminating branches [1, 2] (Figure 1). Figure 1: Pudendal nerve anatomy. Gray’s anatomy, 2011. 3. Case Presentation The patient is a 86-year-old gentleman with a 30-year history of urinary hesitancy and urgency. The patient also had pain in the area of the perineum but considered it a secondary issue. In 1953,
Finite element modeling and in vivo analysis of electrode configurations for selective stimulation of pudendal afferent fibers
John P Woock, Paul B Yoo, Warren M Grill
BMC Urology , 2010, DOI: 10.1186/1471-2490-10-11
Abstract: A finite element model (FEM) of the male cat urethra and surrounding structures was generated to simulate IES with a variety of electrode configurations and locations. The activating functions (AFs) along pudendal afferent branches innervating the cat urethra were determined. Additionally, the thresholds for activation of pudendal afferent branches were measured in α-chloralose anesthetized cats.Maximum AFs evoked by intraurethral stimulation in the FEM and in vivo threshold intensities were dependent on stimulation location and electrode configuration.A ring electrode configuration is ideal for IES. Stimulation near the urethral meatus or prostate can activate the pudendal afferent fibers at the lowest intensities, and allowed selective activation of the dorsal penile nerve or cranial sensory nerve, respectively. Electrode location was a more important factor than electrode configuration for determining stimulation threshold intensity and nerve selectivity.Pudendal nerve stimulation is a potential means of restoring bladder function to persons with spinal cord injury (SCI). Stimulation of sensory (afferent) fibers either in the dorsal penile branch (DNP) or the cranial sensory branch (CSN) of the pudendal nerve can evoke stimulation frequency-dependent contraction or relaxation of the urinary bladder in cats [1,2]. However, the existence of comparable reflexes in persons with SCI remains unclear. In both experimental and clinical settings, intraurethral electrical stimulation (IES) has been utilized as a minimally invasive method to investigate these reflexes. However, the activation of multiple nerve pathways (pudendal and pelvic) by this approach did not enable identification of the specific sensory nerves responsible for the evoked bladder reflexes. The present study used a finite element model (FEM) and parallel in vivo measurements in the male cat to quantify the effects of electrode configuration and position on intraurethral activation of pudendal afferent n
Anomalous Branch of Internal Pudendal Artery
Amorim Júnior,Adelmar Afonso de; Amorim,Marleyne José Afonso Accioly Lins; Lins,Carla Cabral dos Santos Accioly; Alvim,Marconi Martins Simoes; Araújo,Felipe Purcell de; Queiroz,Nadieska Sales Araújo;
International Journal of Morphology , 2007, DOI: 10.4067/S0717-95022007000100009
Abstract: the ischiatic artery classically described as a branch of the inferior gluteal artery, is a long and thin vessel that is related to the ischiatic nerve. in a dissection was observed that this artery emerges from the internal pudendal artery with a caliber larger than the ones described in the literature. the knowledge of anatomical variations is important to the surgeons, radiologists and anatomists
Proprioceptive reflexes in exodeviations  [cached]
Garg Rajiv,Menon Vimala,Prakash Prem
Indian Journal of Ophthalmology , 1988,
Abstract: The importance of non-optical ocular reflexes is being increasingly realised. The existence of proprioceptive afferents from the extra ocular muscles has been known for a long time but their contribution towards the control of eye movement is not yet clear. Ishikawa (1978) demonstrated the reverse phase reflex; movement of the eye′. The Magician′s forceps phenomenon was demonstrated by Mitsui et. al (1979) in exodeviation [2]sub . In the present study these two proprioceptive reflexes were studied in exodeviations.
Vaginoplasty with a Pudendal-Thigh Flap in Intersexuals
Acta Medica Okayama , 2008,
Abstract: We treated 2 different types of intersexual patients who underwent a vaginoplasty with the pudendal-thigh flap. One was a female with testicular feminization syndrome for whom we reconstructed the total vagina with a pudendal-thigh flap, and the other was a female with an adrenogenital syndrome for whom we enlarged the introitus of the vagina with the same approach. There were no complications such as a flap necrosis. In addition, there was no stricture of the neo-vagina and no urinary problem.
Primitive reflexes and cognitive function
Damasceno, Alfredo;Delicio, Adriane M.;Mazo, Daniel F.C.;Zullo, Jo?o F.D.;Scherer, Patricia;T.Y. Ng, Ronny;Damasceno, Benito P.;
Arquivos de Neuro-Psiquiatria , 2005, DOI: 10.1590/S0004-282X2005000400004
Abstract: background: data on the prevalence of primitive reflexes (pr) in adulthood, their pathological significance and relationship to age and cognition are controversial. objective: to study the relationship between pr and cognition in 30 patients with probable alzheimer's disease (ad) and 154 control subjects. method: diagnosis of probable ad was based on dsm-iv, nincds-adrda, and camdex criteria. primitive reflexes were quantified from zero (absent) to 1 (mild) or 2 (markedly present). the cognitive abilities screening instrument - short form (casi-s) was used to evaluate registration, temporal orientation, verbal fluency and recall. a drawing test was added. results: most frequent pr among demented and controls were suck (77% and 62%, respectively) and snout (60% and 27%), followed by glabellar (30% and 19%), paratonia (37% and 5%), and palmomental (23% and 5%). none of controls had more than three pr. frequency of pr tended to increase with age and cognitive deterioration. grasp and babinski responses were found only in dementia patients. primitive reflexes were not correlated with each other, except snout with suck, and snout with glabellar reflex. conclusion: the finding of grasp and babinski sign, or the presence of more than three primitive signs, particularly the combination of paratonia, snout, suck, and palmomental reflexes strongly suggests brain dysfunction, especially when these signs are marked and accompanied by deficits in orientation, recall, verbal fluency, and constructional praxis.
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