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A minimally invasive, endoscopic transgluteal procedure for pudendal nerve and inferior cluneal nerve neurolysis in case of entrapment: 3- and 6-month results. The ENTRAMI technique for neurolysis

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Abstract

Background

Pudendal and cluneal nerve entrapment can cause a neuropathic pain syndrome in the sensitive areas innervated by these nerves. Recently, a new endoscopic minimal invasive approach for pudendal and inferior cluneal nerve neurolysis has been published in a cadaver study. The aim of our study was to describe the feasibility of this new approach and to evaluate the clinical outcome.

Methods

Fifteen patients underwent the ENTRAMI technique. The Numeric Pain Rating Scale (NPRS) and Patient Global Impression of Change (PGIC) were recorded at baseline and at 3 and 6 months after surgery.

Result

The average duration of intervention (skin to skin) was 139 min (range 50–270 min) for bilateral pudendal neurolysis and/or cluneal neurolysis and 113 min (range 100–130 min) for unilateral pudendal and/or cluneal neurolysis. No perioperative blood loss occurred. At 3 months, 50% of patients declared a more than 30% improvement of their PGIC, increasing to 57% at 6 months; 31% reported more than 90% improvement of PGIC at 6 months. Overall reduction of the average maximal NPRS score was from 9 (range 7–10) to 6 at 3 months (range 0–10; p value < 0.05) and to 5 at 6 months (range 0–10; p value < 0.05). There were no postoperative complications.

Conclusions

The ENTRAMI technique is feasibly in patients suffering from pudendal and/or cluneal neuralgia and preliminary results are promising.

Clinical trial number:

NCT03883178

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Correspondence to Katleen Jottard.

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Ethical approval

The ethics committee of the Centre Hospitalier Universitaire-Universitair verpleegcentrum Brugmann (CHU-UVC Brugmann) approved the protocol (EC number: 2017/78).

Conflict of interest

The authors declare that they have no conflict of interest.

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The manuscript was accepted as “short oral presentation” on 5th September 2019 at the International Continence Society Gothenburg Sweden (3–6 September 2019). The abstract from that presentation was published in Neurology and Urodynamics Journal, https://doi.org/10.1002/nau.24118.

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Jottard, K., Bruyninx, L., Bonnet, P. et al. A minimally invasive, endoscopic transgluteal procedure for pudendal nerve and inferior cluneal nerve neurolysis in case of entrapment: 3- and 6-month results. The ENTRAMI technique for neurolysis. Int J Colorectal Dis 35, 361–364 (2020). https://doi.org/10.1007/s00384-019-03480-2

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