Pudendal nerve entrapment syndrome (PNES) is a rare condition that causes chronic pelvic pain and may involve voiding dysfunction. PNES diagnosis is difficult and often requires neurophysiological testing (1,2). Surgical intervention becomes necessary when conservative treatments are ineffective (3). We aim to present a case of a laparoscopic approach to pudendal nerve decompression aided by intraoperative neuromonitoring (pIOM) for optimized outcomes. In cases of concurrent voiding dysfunction, pudendal neuromodulation is integrated to enhance functional recovery.

From 2021 to 2023, ten patients with PNES diagnosis underwent laparoscopic decompression with pIOM®. We present a case of a 37-year-old woman with chronic pelvic pain, defecatory dysfunction, and urinary retention managed by clean intermittent catheterization. Clinical presentation, neurophysiological testing, and response to pudendal nerve infiltration confirmed the PNES diagnosis. This procedure utilized pIOM® to support anatomical precision and avoid nerve injury and pudendal neuromodulation to regulate the genitourinary and gastrointestinal systems

Pudendal nerve intraoperative neuromonitoring (pIOM®) facilitated precise nerve identification, improving surgical accuracy and reducing iatrogenic risk. Post-surgery, 60% of patients reported significant relief, 20% moderate improvement, and 20% no change (10 patients in 2 years). The presented patient experienced complete pain relief, normal defecatory function, and achieved spontaneous micturition, supported by pudendal neuromodulation.

Pelvic intraoperative neuromonitoring (pIOM) enhances the effectiveness of pudendal nerve decompression surgery by improving nerve identification and avoiding injury, ultimately supporting better clinical outcomes. Pudendal neuromodulation significantly improves quality of life post-surgery in patients with overactive bladder, urinary retention, and defecatory dysfunction

Luesma MJ, Galé I, Fernando J. Diagnostic and therapeutic algorithm for pudendal nerve entrapment syndrome. Medicina clinica. Jul 23 2021;157(2):71-78. Algoritmo diagnóstico y terapéutico del síndrome de atrapamiento del nervio pudendo. doi:10.1016/j.medcli.2021.02.012
Fanucci E, Manenti G, Ursone A, et al. Role of interventional radiology in pudendal neuralgia: a description of techniques and review of the literature. La Radiologia medica. Apr 2009;114(3):425-36. doi:10.1007/s11547-009-0371-0
Robert R, Labat JJ, Bensignor M, et al. Decompression and transposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation. European urology. Mar 2005;47(3):403-8. doi:10.1016/j.eururo.2004.09.003