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Laparoscopic treatment of pudendal nerve and artery entrapment improves erectile dysfunction in healthy young males

Abstract

Erectile dysfunction (ED) is increasingly becoming more common in young healthy males and is attributed mainly to psychogenic causes in these patients. Recent studies have reported that ED could be secondary to pudendal nerve or artery entrapment. This perspective assessed the efficacy of laparoscopic pudendal nerve and artery decompression in young patients suffering from refractory ED, associated to a pudendal nerve entrapment syndrome. After excluding patients with psychological ED and venous leakage, five young male patients with a history of both ED and pudendal nerve entrapment syndrome diagnosed based on the Nantes criteria were recruited. Pudendal nerve and artery release was performed using a laparoscopic transperitoneal approach. International Index for Erectile Function (IIEF-5) and erectile hardness score (EHS) improved significantly in all patients, 3 months after surgery. Pudendal nerve and artery entrapment could be therefore a reversible cause of ED in young healthy males, and its treatment by laparoscopic pudendal nerve and artery decompression seems to be safe and effective.

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Fig. 1: Main surgery steps.
Fig. 2: Improvement of erectile function after pudendal nerve and artery decompression.

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References

  1. Lizza EF, Rosen RC. Definition and classification of erectile dysfunction: report of the Nomenclature Committee of the International Society of Impotence Research. Int J Impot Res. 1999;11:141–3.

    Article  CAS  Google Scholar 

  2. Lyngdorf P, Hemmingsen L. Epidemiology of erectile dysfunction and its risk factors: a practice-based study in Denmark. Int J Impot Res. 2004;16:105–11.

    Article  CAS  Google Scholar 

  3. Rastrelli G, Maggi M. Erectile dysfunction in fit and healthy young men: psychological or pathological? Transl Androl Urol. 2017;6:79–90.

    Article  Google Scholar 

  4. Berry MD, Berry PD. Contemporary treatment of sexual dysfunction: reexamining the biopsychosocial model. J Sex Med. 2013;10:2627–43.

    Article  Google Scholar 

  5. Kim S-C, Lee Y-S, Seo K-K, Jung G-W, Kim T-H. Reasons and predictive factors for discontinuation of PDE-5 inhibitors despite successful intercourse in erectile dysfunction patients. Int J Impot Res. 2014;26:87–93.

    Article  CAS  Google Scholar 

  6. Israilov S, et al. Intracavernous injections for erectile dysfunction in patients with cardiovascular diseases and failure or contraindications for sildenafil citrate. Int J Impot Res. 2002;14:38–43.

    Article  CAS  Google Scholar 

  7. Antonini G, et al. Minimally invasive infrapubic inflatable penile prosthesis implant for erectile dysfunction: evaluation of efficacy, satisfaction profile and complications. Int J Impot Res. 2016;28:4–8.

    Article  CAS  Google Scholar 

  8. Baltaci S, Aydos K, Kosar A, Anafarta K. Treating erectile dysfunction with a vacuum tumescence device: a retrospective analysis of acceptance and satisfaction. Br J Urol. 1995;76:757–60.

    Article  CAS  Google Scholar 

  9. Donatucci CF, Lue TF. Erectile dysfunction in men under 40: etiology and treatment choice. Int J Impot Res. 1993;5:97–103.

    CAS  PubMed  Google Scholar 

  10. Gemery JM, Nangia AK, Mamourian AC, Reid SK. Digital three-dimensional modelling of the male pelvis and bicycle seats: impact of rider position and seat design on potential penile hypoxia and erectile dysfunction. BJU Int. 2007;99:135–40.

    Article  Google Scholar 

  11. Cherington M. Hazards of bicycling: from handlebars to lightning. Semin Neurol. 2000;20:247–53.

    Article  CAS  Google Scholar 

  12. Leibovitch I, Mor Y. The vicious cycling: bicycling related urogenital disorders. Eur Urol. 2005;47:277–86.

    Article  Google Scholar 

  13. Naouar S, Braiek S, Kamel RE. Erectile dysfunction secondary to pudendal nerve injury complicating orthopedic surgery: practical recommandations. J Curr Surg. 2017;7:1–3.

    Article  Google Scholar 

  14. Shafik A. Pudendal artery syndrome with erectile dysfunction: treatment by pudendal canal decompression. Arch Androl. 1995;34:83–94.

    Article  CAS  Google Scholar 

  15. Labat J-J, et al. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn. 2008;27:306–10.

    Article  Google Scholar 

  16. Shamloul R, Ghanem H, Abou-zeid A. Validity of the Arabic version of the sexual health inventory for men among Egyptians. Int J Impot Res. 2004;16:452–5.

    Article  CAS  Google Scholar 

  17. Arafa M, Shamloul R. The arabic version of the erection hardness score. J Sex Med. 2009;6:3501–3.

    Article  Google Scholar 

  18. Erdogru T, Avci E, Akand M. Laparoscopic pudendal nerve decompression and transposition combined with omental flap protection of the nerve (Istanbul technique): technical description and feasibility analysis. Surg Endosc. 2014;28:925–32.

    Article  Google Scholar 

  19. Katayama H, et al. Extended clavien-dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46:668–85.

    Article  Google Scholar 

  20. Giuliano F. Neurophysiology of erection and ejaculation. J Sex Med. 2011;8:310–5.

    Article  Google Scholar 

  21. Popeney C, Ansell V, Renney K. Pudendal entrapment as an etiology of chronic perineal pain: diagnosis and treatment. Neurourol Urodyn. 2007;26:820–7.

    Article  Google Scholar 

  22. Nolan MW, et al. Pudendal nerve and internal pudendal artery damage may contribute to radiation-induced erectile dysfunction. Int J Radiat Oncol Biol Phys. 2015;91:796–806.

    Article  Google Scholar 

  23. Cvetanovich GL, et al. Anatomy of the pudendal nerve and other neural structures around the proximal hamstring origin in males. Arthroscopy. 2018;34:2105–10.

    Article  Google Scholar 

  24. Tricard T, Munier P, Story F, Lang H, Saussine C. The drug-resistant pudendal neuralgia management: a systematic review. Neurourol Urodyn. 2019;38:13–21.

    Article  Google Scholar 

  25. Shafik A. Pudendal canal decompression in the treatment of erectile dysfunction. Arch Androl. 1994;32:141–9.

    Article  CAS  Google Scholar 

  26. Luther RD, Castellanos ME. Successful treatment of penile numbness and erectile dysfunction resulting from pudendal nerve entrapment. Urology. 2019;134:228–31.

    Article  Google Scholar 

  27. Menorca RMG, Fussell TS, Elfar JC. Peripheral nerve trauma: mechanisms of injury and recovery. Hand Clin. 2013;29:317–30.

    Article  Google Scholar 

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Correspondence to Fouad Aoun.

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Aoun, F., Mjaess, G., Daher, K. et al. Laparoscopic treatment of pudendal nerve and artery entrapment improves erectile dysfunction in healthy young males. Int J Impot Res 33, 1–5 (2021). https://doi.org/10.1038/s41443-020-0287-8

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