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      Actualización del síndrome de atrapamiento del nervio pudendo: enfoque anatómico-quirúrgico, diagnóstico y terapéutico

      Actas Urológicas Españolas
      Asociación Española de Urología
      Pudendal nerve, Pudendal nerve entrapment syndrome, Pelvic floor neuropathic pain, Pelvic floor myofascial syndrome, Pudendal nerve decompression, Nervio pudendo (NP), Atrapamiento del nervio pudendo (SANP), Dolor neuropático del suelo pélvico, Síndrome miofascial de suelo pélvico, Descompresión del nervio pudendo

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          Abstract

          Introducción: El síndrome de atrapamiento del nervio pudendo (SANP) es un gran desconocido y suele ser mal diagnosticado o confundido con otras patologías. Fue descrito por primera vez por Amarenco en 1987. La manifestación clínica clásica es la neuralgia del pudendo, un dolor neuropático del área genital. Objetivos: Dar a conocer su existencia a los profesionales de la urología a través de una revisión sistemática de la bibliografía existente y sus posibilidades de diagnostico y tratamiento. Material y método: Realizamos una búsqueda bibliográfica a través de la base de datos «Pubmed» utilizando los términos «Pudendal nerve», «Pudendal nerve entrapment síndrome», «Pelvic floor neuropathic pain», «Pelvic floor myofascial síndrome», «Pudendal nerve decompression». Asimismo, seleccionamos los trabajos en lengua inglesa, española y francesa, revisando también los artículos que dichos trabajos refieren. Resultados: Se desarrollan los aspectos más destacados del síndrome: anatomía, etiología, fisiopatología, diagnostico clínico, ecodoppler de la arteria pudenda interna, estudios electrofisiológicos, criterios diagnósticos, terapéutica médica, tratamiento con fisioterapia y tratamiento quirúrgico. Conclusión: Es una causa poco frecuente de dolor en el suelo pélvico y afecta en gran medida la calidad de vida de los pacientes. Hoy, disponemos de herramientas diagnósticas y terapéuticas que nos permiten tratar este síndrome invalidante con buenos resultados.

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          Most cited references61

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          Dry needling to a key myofascial trigger point may reduce the irritability of satellite MTrPs.

          To investigate the changes in pressure pain threshold of the secondary (satellite) myofascial trigger points (MTrPs) after dry needling of a primary (key) active MTrP. Single blinded within-subject design, with the same subjects serving as their own controls (randomized). Fourteen patients with bilateral shoulder pain and active MTrPs in bilateral infraspinatus muscles were involved. An MTrP in the infraspinatus muscle on a randomly selected side was dry needled, and the MTrP on the contralateral side was not (control). Shoulder pain intensity, range of motion (ROM) of shoulder internal rotation, and pressure pain threshold of the MTrPs in the infraspinatus, anterior deltoid, and extensor carpi radialis longus muscles were measured in both sides before and immediately after dry needling. Both active and passive ROM of shoulder internal rotation, and the pressure pain threshold of MTrPs on the treated side, were significantly increased (P < 0.01), and the pain intensity of the treated shoulder was significantly reduced (P < 0.001) after dry needling. However, there were no significant changes in all parameters in the control (untreated) side. Percent changes in the data after needling were also analyzed. For every parameter, the percent change was significantly higher in the treated side than in the control side. This study provides evidence that dry needle-evoked inactivation of a primary (key) MTrP inhibits the activity in satellite MTrPs situated in its zone of pain referral. This supports the concept that activity in a primary MTrP leads to the development of activity in satellite MTrPs and the suggested spinal cord mechanism responsible for this phenomenon.
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            Impotence and nerve entrapment in long distance amateur cyclists.

            To assess the frequency and duration of symptoms suggesting peripheral nerve compression after long distance cycling. A questionnaire based cross sectional study among 260 participants in a Norwegian annual bicycle touring race of 540 km. Thirty-five of 160 responding males (22%) reported symptoms from the innervation area of the pudendal or cavernous nerves. Thirty-three had penile numbness or hypaesthesia after the tour. In 10, the numbness lasted for more than one week. Impotence was reported by 21 (13%) of the males. It lasted for more than one week in 11, and for more than one month in three. Both genital numbness and impotence were correlated with weakness in the hands after the ride, a complaint reported by 32 (19%) of all 169 respondents. Forty-six cyclists (30%) indicated paraesthesia or numbness in the fingers, half of them from the ulnar nerve area only. The frequency of impotence, numbness of the penis, hand weakness and sensory symptoms from the fingers in bicycle sport may be higher than hitherto recognized. It afflicts both experienced cyclists and novices. In some, the complaints may last up to eight months. Besides changing the hand and body position on the bike, restricting the training intensity, and taking ample pauses may also be necessary in prolonged and vigorous bicycle riding to prevent damage to peripheral nerves.
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              Pudendal neuralgia, a severe pain syndrome.

              To describe the clinical and electrodiagnostic findings, therapies, and outcomes of patients with pudendal neuralgia.
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