vestnovsuВестник Новгородского государственного университетаVestnik of Novgorod State University2076-8052Новгородский государственный университет имени Ярослава Мудрого10.34680/2076-8052.2024.2(136).311-321vestnovsu-311Research ArticleКлиническая медицинаClinical medicineОтдаленные результаты применения пульсовой радиочастотной аблации у пациентов с невропатией половых нервовLong-term outcomes of applying pulsed radiofrequency ablation in patients with pudendal neuropathyhttps://orcid.org/0000-0001-9039-9147СтепановИ. А.StepanovI. A.

Степанов Иван Андреевич – ассистент кафедры

Иркутск

Irkutsk

edmoilers@mail.ruhttps://orcid.org/0000-0002-3299-1924БелобородовВ. А.BeloborodovV. A.

Белобородов Владимир Анатольевич – доктор медицинских наук, профессор, заведующий кафедрой

Иркутск

Irkutsk

BVA555@yAndex.ruИркутский государственный медицинский университет; Харлампиевская клиникаРоссияIrkutsk State Medical University; Kharlampiev ClinicRussian FederationИркутский государственный медицинский университетРоссияIrkutsk State Medical UniversityRussian Federation20243007202402(136)311321Copyright © Степанов И.А., Белобородов В.А., 20242024Степанов И.А., Белобородов В.А.Stepanov I.A., Beloborodov V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestnovsu.elpub.ru/jour/article/view/311

В исследование включены медицинские карты 25 пациентов (17 респондентов(68%) женского пола, 8 (32%) – мужского пола, возраст пациентов варьировал от 28 до 80 лет, средний возраст составил 54,5±13,7 лет) с подтвержденным диагнозом невропатии половых нервов (НПН), которым выполнена процедура пульсовой радиочастотной аблации (ПРА) половых нервов. Анализ степени выраженности болевого синдрома по визуальной аналоговой шкале (ВАШ) в сроки 3, 6, 9, 12 и 24 месяца после выполнения процедуры ПРА продемонстрировал достоверное снижение указанного показателя (p В раннем послеоперационном периоде (первые 7 суток после выполнения операции) отмечено статистически значимое улучшение уровня дееспособности пациентов по Oswestry Disability Index (ODI) на 10-15% у 72% (p=0,042). В отдаленном периоде послеоперационного наблюдения за респондентами нами также отмечено достоверное улучшение уровня дееспособности по ODI (p Изучение времени пребывания в сидячем положении респондентов показало статистически значимое увеличение данного показателя с 29±13 мин до 83±37 мин спустя 3 месяца от момента выполнения процедуры ПРА половых нервов и до 86±41 мин спустя 12 месяцев (p нежелательных клинических явлений в изучаемой группе пациентов не отмечено. Процедура ПРА половых нервов является эффективным и безопасным методом малоинвазивного хирургического лечения пациентов с НПН. Клиническая эффективность ПРА половых нервов при долгосрочном периоде послеоперационного наблюдения за пациентами составила 92%.

The study includes medical records of patients with pudendal neuropathy (PN) who underwent the pulsed radiofrequency ablation (PRA) procedure. Clinical parameters and adverse events were studied during the entire perioperative period. The follow-up period for the respondents was at least 24 months. The study includes medical records of 25 patients (17 (68%) female respondents, 8 (32%) male respondents, the age of patients ranged from 28 to 80 years, the average age was 54.5±13.7 years) with a confirmed PN diagnosis, who underwent the PRA procedure of the pudendal nerves. Analysis of the severity of pain syndrome according to visual analogue scale (VAS) at 3, 6, 9, 12 and 24 months after the PRA procedure showed a significant decrease in this indicator (p < 0.001). In the early postoperative period (the first 7 days after the operation), there was a statistically significant improvement in the level of patients’ capacity according to Oswestry Disability Index (ODI) by 10–15% in 72% (p=0.042). In the late period of the respondents’ postoperative observation, we also noted a significant improvement in the level of capacity by ODI (p<0.001). The study of the time spent in the respondents’ sitting position showed a statistically significant increase in this indicator from 29±13 minutes to 83±37 minutes 3 months after the PRA procedure of the pudendal nerves and up to 86±41 minutes after 12 months (p<0.001). There were no significant adverse clinical events in the study group of patients. PRA procedure of pudendal nerves is an effective and safe method of minimally invasive surgical treatment of patients with PN. The clinical efficacy of PRA of the pudendal nerves in the long-term period of patients’ postoperative follow-up was 92%.

невропатия половых нервовхронический нейропатический болевой синдромпульсовая радиочастотная аблацияклиническая эффективностьнежелательные явленияpudendal neuropathychronic neuropathic pain syndromepulsed radiofrequency ablationclinical efficacyadverse eventsReferencesKhoder W., Hale D. Pudendal neuralgia // Obstetrics and Gynecology Clinics of North America. 2014. 41(3). 443-452. DOI: 10.1016/j.ogc.2014.04.002Khoder W., Hale D. Pudendal neuralgia // Obstetrics and Gynecology Clinics of North America. 2014. 41(3). 443-452. DOI: 10.1016/j.ogc.2014.04.002Hibner M., Desai N., Robertson L. J., Nour M. Pudendal neuralgia // Journal of Minimally Invasive Gynecology. 2010. 17(2). 148-153. DOI: 10.1016/j.jmig.2009.11.003Hibner M., Desai N., Robertson L. J., Nour M. Pudendal neuralgia // Journal of Minimally Invasive Gynecology. 2010. 17(2). 148-153. DOI: 10.1016/j.jmig.2009.11.003Spinosa J.-P., de Bisschop E., Laurençon J., Kuhn G., Dubuisson J. B., Riederer B. M. Les réflexes sacrés etagés dans l'etude de la névralgie pudendalte: validation anatomique [Sacral staged reflexes to localize the pudendal compression: an anatomical validation of the concept] // Revue Medicale Suisse. 2006. 2(84). 2416-2421.Spinosa J.-P., de Bisschop E., Laurençon J., Kuhn G., Dubuisson J. B., Riederer B. M. Les réflexes sacrés etagés dans l'etude de la névralgie pudendalte: validation anatomique [Sacral staged reflexes to localize the pudendal compression: an anatomical validation of the concept] // Revue Medicale Suisse. 2006. 2(84). 2416-2421.Извозчиков С. Б. Тазовая боль в практике врача-невролога // Журнал неврологии и психиатрии им. С. С. Корсакова. 2018. 118(4). 94-99. DOI: 10.17116/jnevro20181184194-99Izvozchikov S. B. Tazovaya bol' v praktike vracha-nevrologa [Pelvic pain in neurological practice] // S. S. Korsakov Journal of Neurology and Psychiatry. 2018. 118(4). 94-99. DOI: 10.17116/jnevro20181184194-99Извозчиков С. Б. Механизмы формирования и диагностика туннельных пудендонейропатий // Журнал неврологии и психиатрии им. С. С. Корсакова. 2019. 119(11). 98-102. DOI: 10.17116/jnevro201911911198Izvozchikov S. B. Mekhanizmy formirovaniya i diagnostika tunnel'nykh pudendoneyropatiy [Mechanisms of formation and diagnosis of tunnel pudendal neuropathy] // S. S. Korsakov Journal of Neurology and Psychiatry. 2019. 119(11). 98-102. DOI: 10.17116/jnevro201911911198Pérez-López F. R., Hita-Contreras F. Management of pudendal neuralgia // Climacteric. 2014. 17(6). 654-656. DOI: 10.3109/13697137.2014.912263Pérez-López F. R., Hita-Contreras F. Management of pudendal neuralgia // Climacteric. 2014. 17(6). 654-656. DOI: 10.3109/13697137.2014.912263Luesma M. J., Galé I., Fernando J. Diagnostic and therapeutic algorithm for pudendal nerve entrapment syndrome // Medicina Clínica (English Edition). 2021. 157(2). 71-78. DOI: 10.1016/j.medcli.2021.02.002Luesma M. J., Galé I., Fernando J. Diagnostic and therapeutic algorithm for pudendal nerve entrapment syndrome // Medicina Clínica (English Edition). 2021. 157(2). 71-78. DOI: 10.1016/j.medcli.2021.02.002Chang M. C. Efficacy of Pulsed Radiofrequency Stimulation in Patients with Peripheral Neuropathic Pain: A Narrative Review // Pain Physician. 2018. 21(3). E225-E234. DOI: 10.36076/ppj.2018.3.E225Chang M. C. Efficacy of Pulsed Radiofrequency Stimulation in Patients with Peripheral Neuropathic Pain: A Narrative Review // Pain Physician. 2018. 21(3). E225-E234. DOI: 10.36076/ppj.2018.3.E225Krijnen E. A., Schweitzer K. J., van Wijck A. J. M., Withagen M. I. J. Pulsed Radiofrequency of Pudendal Nerve for Treatment in Patients with Pudendal Neuralgia. A Case Series with Long-Term Follow-Up // Pain Practice. 2021. 21(6). 703-707. DOI: 10.1111/papr.12999Krijnen E. A., Schweitzer K. J., van Wijck A. J. M., Withagen M. I. J. Pulsed Radiofrequency of Pudendal Nerve for Treatment in Patients with Pudendal Neuralgia. A Case Series with Long-Term Follow-Up // Pain Practice. 2021. 21(6). 703-707. DOI: 10.1111/papr.12999Petrov-Kondratov V., Chhabra A., Jones S. Pulsed Radiofrequency Ablation of Pudendal Nerve for Treatment of a Case of Refractory Pelvic Pain // Pain Physician. 2017. 20(3). E451-E454.Petrov-Kondratov V., Chhabra A., Jones S. Pulsed Radiofrequency Ablation of Pudendal Nerve for Treatment of a Case of Refractory Pelvic Pain // Pain Physician. 2017. 20(3). E451-E454.Vandenbroucke J. P., von Elm E., Altman D. G., Gøtzsche P. C., Mulrow C. D., Pocock S. J., Poole C., Schlesselman J. J., Egger M. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration // PLoS Medicine. 2007. 4(10). e297. DOI: 10.1371/journal.pmed.0040297Vandenbroucke J. P., von Elm E., Altman D. G., Gøtzsche P. C., Mulrow C. D Pocock S. J., Poole C., Schlesselman J. J., Egger M. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration // PLoS Medicine. 2007. 4(10). e297. DOI: 10.1371/journal.pmed.0040297Labat J. J., Riant T., Robert R., Amarenco G., Lefaucheur J. P., Rigaud J. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria) // Neurourology and Urodynamics. 2008. 27(4). 306-310. DOI: 10.1002/nau.20505Labat J. J., Riant T., Robert R., Amarenco G., Lefaucheur J. P., Rigaud J. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria) // Neurourology and Urodynamics. 2008. 27(4). 306-310. DOI: 10.1002/nau.20505World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects // Journal of the American Medical Association (JAMA). 2013. 310(20). 2191-2194. DOI: 10.1001/jama.2013.281053World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects // Journal of the American Medical Association (JAMA). 2013. 310(20). 2191-2194. DOI: 10.1001/jama.2013.281053Robert R., Labat J. J., Bensignor M., Glemain P., Deschamps C., Raoul S., Hamel O. Decompression and transposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation // European Urology. 2005. 47(3). 403-408. DOI: 10.1016/j.eururo.2004.09.003Robert R., Labat J. J., Bensignor M., Glemain P., Deschamps C., Raoul S., Hamel O. Decompression and transposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation // European Urology. 2005. 47(3). 403-408. DOI: 10.1016/j.eururo.2004.09.003Ploteau S., Perrouin-Verbe M. A., Labat J. J., Riant T., Levesque A., Robert R. Anatomical Variants of the Pudendal Nerve Observed during a Transgluteal Surgical Approach in a Population of Patients with Pudendal Neuralgia // Pain Physician. 2017. 20(1). E137-E143. DOI: 10.36076/2017.1.E137Ploteau S., Perrouin-Verbe M. A., Labat J. J., Riant T., Levesque A., Robert R. Anatomical Variants of the Pudendal Nerve Observed during a Transgluteal Surgical Approach in a Population of Patients with Pudendal Neuralgia // Pain Physician. 2017. 20(1). E137-E143. DOI: 10.36076/2017.1.E137Pélissié M., Fischbach E., Lecointre L., Faller E., Akladios C. Pudendal Neurolysis by Laparoscopy // Journal of Minimally Invasive Gynecology. 2021. 28(5). 938. DOI: 10.1016/j.jmig.2020.11.003Pélissié M., Fischbach E., Lecointre L., Faller E., Akladios C. Pudendal Neurolysis by Laparoscopy // Journal of Minimally Invasive Gynecology. 2021. 28(5). 938. DOI: 10.1016/j.jmig.2020.11.003Waxweiler C., Dobos S., Thill V., Bruyninx L. Selection criteria for surgical treatment of pudendal neuralgia // Neurourology and Urodynamics. 2017. 36(3). 663-666. DOI: 10.1002/nau.22988Waxweiler C., Dobos S., Thill V., Bruyninx L. Selection criteria for surgical treatment of pudendal neuralgia // Neurourology and Urodynamics. 2017. 36(3). 663-666. DOI: 10.1002/nau.22988Rhame E. E., Levey K. A., Gharibo C. G. Successful treatment of refractory pudendal neuralgia with pulsed radiofrequency // Pain Physician. 2009. 12(3). 633-638. DOI: 10.36076/ppj.2009/12/633Rhame E. E., Levey K. A., Gharibo C. G. Successful treatment of refractory pudendal neuralgia with pulsed radiofrequency // Pain Physician. 2009. 12(3). 633-638. DOI: 10.36076/ppj.2009/12/633Chang M. C. Efficacy of Pulsed Radiofrequency Stimulation in Patients with Peripheral Neuropathic Pain: A Narrative Review // Pain Physician. 2018. 21(3). E225-E234. DOI: 10.36076/ppj.2018.3.E225Chang M. C. Efficacy of Pulsed Radiofrequency Stimulation in Patients with Peripheral Neuropathic Pain: A Narrative Review // Pain Physician. 2018. 21(3). E225-E234. DOI: 10.36076/ppj.2018.3.E225Teixeira A., Sluijter M. E. Intradiscal high-voltage, long-duration pulsed radiofrequency for discogenic pain: a preliminary report // Pain Medicine. 2006. 7(5). 424-428. DOI: 10.1111/j.1526-4637.2006.00148.xTeixeira A., Sluijter M. E. Intradiscal high-voltage, long-duration pulsed radiofrequency for discogenic pain: a preliminary report // Pain Medicine. 2006. 7(5). 424-428. DOI: 10.1111/j.1526-4637.2006.00148.xCahana A., Van Zundert J., Macrea L., van Kleef M., Sluijter M. Pulsed radiofrequency: current clinical and biological literature available // Pain Medicane. 2006. 7(5). 411-423. DOI: 10.1111/j.1526-4637.2006.00148.xCahana A., Van Zundert J., Macrea L., van Kleef M., Sluijter M. Pulsed radiofrequency: current clinical and biological literature available // Pain Medicane. 2006. 7(5). 411-423. DOI: 10.1111/j.1526-4637.2006.00148.xFang H., Zhang J., Yang Y., Ye L., Wang X. Clinical effect and safety of pulsed radiofrequency treatment for pudendal neuralgia: a prospective, randomized controlled clinical trial // Journal of Pain Research. 2018. 11. 2367-2374. DOI: 10.2147/JPR.S167866Fang H., Zhang J., Yang Y., Ye L., Wang X. Clinical effect and safety of pulsed radiofrequency treatment for pudendal neuralgia: a prospective, randomized controlled clinical trial // Journal of Pain Research. 2018. 11. 2367-2374. DOI: 10.2147/JPR.S167866Ozkan D., Akkaya T., Yildiz S., Comert A. Ultrasound-guided pulsed radiofrequency treatment of the pudendal nerve in chronic pelvic pain // Der Anaesthesist. 2016. 65(2). 134-136. DOI: 10.1007/s00101-015-0133-4Ozkan D., Akkaya T., Yildiz S., Comert A. Ultrasound-guided pulsed radiofrequency treatment of the pudendal nerve in chronic pelvic pain // Der Anaesthesist. 2016. 65(2). 134-136. DOI: 10.1007/s00101-015-0133-4

The authors declare that there are no conflicts of interest present.