Our country continues to lead important advances in science and medicineand its professionals put their efforts into developing techniques and procedures that put an end to the most limiting pathologies in the quality of life of their patients.
(The technique of the robotic female artificial sphincter that ends urinary incontinence)
This is the case, for example, of pudendal nerve entrapment −more colloquially known as the cyclist syndrome−, a condition that, despite causing intense pain and affecting the daily life of its patients, is also often confused with other pathologies and its treatment requires complex but increasingly effective technologies, such as robotic surgery.
From store we talked to the doctor David Carracedo, head of the Functional-Female Urology Unit at ROC Clinicto better understand how this pathology affects our health and what this innovative solution that for six years It has been successfully implemented in Spanish hospitals.
Nerve entrapment: why does it occur?
He pudendal nerve entrapment It is produced, as its name indicates, in this nerve that runs from the interior of the minor pelvis, passing through all the branches that are in charge of carrying out the functions of the nerve.
Their functionsIn addition to “collecting the sensitivity of the anal canal, vagina or urethra” it includes others such as acting on the sphincter nerves, “responsible for urinary and fecal continence”, explains the expert.
precisely his anatomy complex it is what makes this nerve susceptible to entrapment. When this happens, it is because, previously, at some point in its journey, the nerve has been compressed, altering its normal functioning and causing pain in those who suffer from it.
This pathology, Despite being a great unknown to many, it can be very disabling and “frequently appears associated with urological, digestive or even sexual symptoms“.
Often confused with neuralgiaalthough we must make a distinction between the two termsand it is that, although the entrapment in the pudendal nerve leads to its neuralgia, not in all cases these pains are due to compression.
It was initially described in 1987 as the cyclist syndromebecause the common factor of the first diagnoses is that they belonged to patients who practice cycling professionally or intensively. Today, it is proven that the syndrome, although it can affect both men and women, is three times more frequent in them.
Your symptoms and diagnosis
“The fundamental symptomatology of pudendal nerve entrapment syndrome is the Chronic pain located in the genital area. Patients describe this sensation as a burning pain that worsens when sitting and improves when lying down or walkingbut it doesn’t wake them up at night,” explains the specialist.
Person with discomfort in the pelvic area when sitting.
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Despite being a relatively common pathology, its diagnosis constitutes a major challenge for physiciansprecisely because of the importance of taking a correct clinical history and a detailed physical examination.
The first thing you notice is if the patient has symptoms compatible with this syndrome and if the Physical examination also corroborates it. Although The diagnostic is fundamentally clinical“also we rely on tools that allow us to support it”says the expert, as the neurophysiological study.
“All these processes are complex and on many occasions the diagnosis is delayed, so It is essential that the evaluation of these patients be carried out by doctors specialized in pelvic pain.“.
Robotic surgery, a pioneering treatment
When treating this pathology, specialists relieve the pain of their patients in stages, first with techniques less intenseas physiotherapyand then with others that are moresuch as the infiltration of anesthesia and corticosteroids.
The moment none of these methods work is when robotic surgery comes into play. This technique, in short, seeks release the nerve from the areas that compress it y reverse all symptoms that are limiting the life of the patient so much.
Once in the operating room, the team uses robotic assistance to have better vision and go creating, meticulously, small incisions through which they will locate and release the nerve from all its route until it comes out of the pelvis.
To do this, explain storein addition to relying on robots in order to “have a better vision”, they also use techniques neuronavigation for make sure this nerve has not been damaged during surgeryand detect possible improvements from the first moment.
A process that, in addition to being beneficial for patients, also it is very comfortable before and after the operation.
The only thing that is asked of them is to “fast eight hours before”, and, as post-operative, once they are discharged at 24 hours, which is recommended Do not make great efforts in the first four to six weeks after surgery. “After this, they will be able to carry out their lives as normal and without limitations.”
In addition to this, another of the aspects most celebrated by professionals as far as this formula is concerned is in the success ratearound 70% of the cases.
“Robotic surgery brings great advantages over laparoscopic surgery: three-dimensional vision, enlarged vision to work in small spaces, greater precision in the movement of surgical instruments, suppresses the tremor of the surgeon’s hands, lower risk of bleeding and transfusion, less postoperative pain and shorter hospital stay. All of them are especially important when we work in small spaces such as the pelvis and with small structures such as the pudendal nerve,” concludes the ROC Clinic specialist.
This pioneering technique, minimally invasive and, above all, successfulwas implemented in our country in 2017. Since then it has not stopped developing, and specialists such as David Carracedo are confident that “it will continue to undergo great changes and novelties over the next few years for the benefit of patients.”
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