Vol.:(0123456789) 1 3 Surgical Endoscopy https://doi.org/10.1007/s00464-020-08092-4 Laparoscopic transperitoneal pudendal nerve and artery release for pudendal entrapment syndrome Renaud Bollens 1,2  · Georges Mjaess 3  · Julien Sarkis 3  · Anthony Kallas Chemaly 3  · Elie Nemr 3  · Karim Daher 4  · Albert Semaan 3  · Josselin Abi Chebel 3  · Fabienne Absil 5  · Fouad Aoun 3,6 Received: 25 June 2020 / Accepted: 3 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Introduction Pudendal nerve and artery entrapment is an underdiagnosed pathology responsible of several urinary, sexual and anorectal complaints. The aim of our study was to evaluate safety and feasibility of laparoscopic transperitoneal pudendal nerve and artery release in a large retrospective cohort of patients with pudendal nerve entrapment syndrome with both a short and long-term follow-up. Technical details and outcomes are also reported. Methods A series of 235 patients with pudendal syndrome underwent laparoscopic transperitoneal pudendal canal release between June 2015 and February 2020. Operative data were recorded prospectively for all patients. A complete history, pain visual analog scale (VAS) for perineodynia, and three scores evaluating the main symptoms (USP, IIEF-5, PAC-SYM) were obtained before and at least 24 months after surgery for 32 patients only. Post-operative complications were also evaluated using Clavien-Dindo classifcation at regular interval. Results The mean operating time per side was 33.9 ± 6.8 min and the average hospital stay was 1.9 ± 0.3 days. Blood loss was 20 cc ± 10 cc with no patients needing transfusion. The only signifcant per-operative complication was hemorrhage (600 ml) in one patient induced by a pudendal artery laceration, successfully treated by laparoscopic suturing. Post-operative complications were noted in 18.7% of patients with no serious Clavien-Dindo complications. Perineodynia VAS dropped from 6.8 ± 0.9 to 2.2 ± 1.8 after surgery (p < 0.001). Mean IIEF-5 scores signifcantly improved one month after the surgery (15.2 vs 19.3, p = 0.036). Mean USP scores signifcantly improved for the dysuria domain (4.2 vs 1.6, p = 0.021) but not for stress urinary incontinence (3.9 vs 4.1, p = 0.082) or overactive bladder symptoms (14.1 vs 13.8, p = 0.079). Mean PAC-SYM scores signifcantly improved after the procedure (1.8 vs 1.1, p < 0.001). Conclusion A complete laparoscopic pudendal nerve and artery release, from the sciatic spine through the Alcock’s canal, is a fast and safe surgery with promising functional results. A large prospective trial is needed to validate such an approach. Keywords Pudendal nerve · Pudendal artery · Laparoscopic nerve release · Laparoscopic nerve decompression Pudendal neuralgia (PN) is one of the most underdiagnosed causes of chronic pelvic pain, a condition afecting deeply the quality of life of patients [1]. It is caused mainly by the entrapment of the pudendal nerve in two main anatomical locations during its passage into the pelvis: between sac- rospinous and sacrotuberous ligaments (which constitutes the most common level of entrapment), and at the level of Alcock’s canal, a duplication of the obturator muscle’s fas- cia [2]. Other uncommon anatomical entrapment locations are below the piriformis muscle and the entrapment of the pudendal nerve’s terminal branches [2]. This condition is known as the “pudendal nerve entrapment syndrome”. Pain in the territory of the pudendal nerve is not constant and clinical manifestations can be limited to urinary, sexual and/ or anorectal symptoms. and Other Interventional Techniques * Fouad Aoun fouad.aoun@bordet.be 1 Wallonie Picarde Hospital, Tournai, Belgium 2 Department of Urology, Université Nord de France, St Phillibert Hospital, Lille, France 3 Hotel-Dieu de France, Université Saint Joseph, Beirut, Lebanon 4 Rizk Hospital (LAU Medical Center), Beirut, Lebanon 5 Gynecology Department, EpiCURA Hospital, Ath, Belgium 6 Urology Department, Institut Jules Bordet, Brussels, Belgium