Pudendal Neuropathy is Not Related to Physiologic Pelvic Outlet Obstruction

CARLOS A. VACCARO; STEVEN D WEXNER; TIONG-ANN TEOH; SANG KYUNG CHOI; CHEONG DM; SALANGA VD

DISEASES OF THE COLON AND RECTUM.

LIPPINCOTT WILLIAMS & WILKINS

Lugar: Philadelphia; Año: 1995

0012-3706

Chronic straining because of pelvic outlet obstruction is hypothesized to cause pudendal neuropathy (PN) by stretch injury. PURPOSE: The aim of this study was to determine any association between PN and pelvic outlet obstruction. METHODS: One hundred forty-seven constipated patients were evaluated by cinedefecography and pudendal nerve terminal motor latency assessment. PN was defined as a latency longer than 2.2 ms. Pelvic outlet obstructive pat- terns of evacuation included paradoxic contraction, nonre- laxation of the puborectalis muscle, or failure of opening of the anal canal. RESULTS: Median length of constipation including straining during evacuation was eight (range, 1-47) years. Ninety-one (62 percent) subjects had a normal pattern of evacuation, and 56 (38 percent) had an ob- structed pattern. Both groups had a similar median age (68 vs. 69 years, respectively; P > 0.05) and same median length of symptoms. Overall incidence of PN was 23.8 percent (10.9 percent tmilateral and 12.9 percent bilateral). There was no difference in the incidence of PN between patients with normal evacuation and patients with ob- structed evacuation (24.2 percent vs. 23.2 percent, respec- tively; P > 0.05). Patients with PN had a similar incidence of physiologic pelvic outlet obstruction as did patients with- out PiN. However, median age of patients with PN was higher than those without PN (73 vs. 66 years, respectively; P > 0.05). CONCLUSION: There was a difference in the incidence of PN between normal and obstructed patterns of evacuation. Therefore, the espoused theory that obstructed defecation causes PN appears flawed.