Clinical Differential Diagnosis Of Male Pudendal Neuralgia In Urology And Andrology

Objective: to explore the main points of diagnosis and treatment of pudendal neuralgia,analyze the causes of misdiagnosis,and improve the diagnosis and treatment of pain in the perineal region by urological andrology.Methods: To analyze the data of 28 male patients with pudendal neuralgia who were misdiagnosed in our department of Urology and Andrology and Pain from June 2014 to November 2017,It includes clinical data of symptoms,signs,VAS pain scores and auxiliary examinations of before and after treatment and misdiagnosis,treatment effect.All cases were diagnosed and treated by experienced urological andrology and pain physicians,all the patients were included in with the PN diagnostic standard "Nantes criteria".For patients diagnosed with PN,oral gabapentin therapy was given,300 mg Tid,1 months of treatment;The pudendal nerve block was applied to patients with VAS or more than 7 or with a poor oral medication,The VAS score,symptoms and local signs were used to comprehensive evaluate the effect.Results:The age of the patients was 37.7 + 9.4 years,and the course of disease was 5.6 + 1.4 months;Common typical symptoms and signs:Unilateral(28/28);perineal pain / discomfort(17/28),scrotal pain / discomfort(14/28);Prickling pain(12/28),burning pain(8/28)and radiation pain(8/28)were the main causes;The sitting position can induce or aggravate(16/28);Combined voiding stimulation(8/28)and sexual dysfunction(5/28);Positive sciatic acanthosis(16/28).Laboratory and ultrasound examination:The normal WBC in the prostatic fluid was elevated(10/28).Prostatic calcification(6/28),epididymal nodule(3/28),varicocele(3/28).Misdiagnosis: CP(19/28),testicular pain(4/28),I degree varicocele(3/28),testicular epididymitis(2/28).Compared with before treatment,the VAS score was significantly lower after treatment(p<0.05),the cure rate(28.6%),the effective rate(32.1%),and the effective rate(39.3%),and no significant difference in the follow-up VAS score after 3 months(p>0.05).Conclusion: Male pudendal neuralgia has unilateral perineal region and scrotal pain / discomfort,With prickling,burning and radiating pain,And often accompanied by the characteristics of the sciatic acanthosis.Clinically,attention should be paid to identifying CP,testicular pain,varicocele and other diseases.PN is the first choice for the treatment of gabapentin capsule,For patients with severe pain and poor drug efficacy,nerve block therapy can be used.