Laparoscopic Prostate Removal
for Severe, Treatment-Resistant
Chronic Prostatitis

                                                                            

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Pudendal Nerve Release

Pudendal Nerve ReleaseThe pudendal nerve originates in the S2-S4 region of the spinal cord and provides motor and sensory innervation to the perineum, penis, and scrotum. As it courses, the pudendal nerve passes through a tight spot known as the pudental canal, also known as Alcock's Canal. As can happen to the median nerve and sciatic nerve in the more familiar Carpal Tunnel Syndrome and Sciatica, respectively, the pudendal nerve may be traumatized, which can cause pain. 

There has been some effort, more so in the field of gynecology, to release the pudendal nerve for the relief of pain. The surgical procedure to treat pudendal nerve trauma is known as pudendal nerve release. As of September, 2010, the National Library of Medicine lists only 11 English-language scientific articles on pudendal nerve release. In other words, we know very little about its role in clinical practice.

With regards to chronic prostatitis, a paper was presented at the 2008 meeting of the American Urological Association relating to 31 patients with "prostatitis-like pain" who had bilateral transgluteal (throuth the buttocks) pudendal nerve release. 

Here are the details:
  •   9 were not evaluable for reasons that are not given
  • 22 were evaluable 
  • 12 improved: their CPSI scores decreased from 31.6 to 23.3 one year later
  •   7 saw no change
  •   3 worsened
In the 12/31 (39%) of the patients who improved, there was an observed 8.3-point average drop in symptom score; this level of drop equates with the historical effects of pollen extract and global therapeutic massage

Overall, the data from 19 out of 31 enrolled patients were censored, for reasons of not being evaluable, which is not further defined, or for reasons failing treatment or getting worse. If one assumes for argument's sake that the symptom scores of the 19 whose data were censored did not change at all, then the average drop in symptom score would be approximately 3, which equates with the historical effect of placebo. 

In other words, to the best of our knowledge, the only data relating to pudendal nerve release that have been publicly presented at all illustrate at best a marginal effect, on average seemingly no better than what is seen with over-the-counter supplements, massage, and placebo.
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