Transgluteal Decompression of the Pudendal Nerve in Pudendal Neuralgia: Implications of Sacrospinous Ligament Resection

Objective: This study evaluated the efficacy of pudendal nerve decompression via the transgluteal approach for pudendal neuralgia and examined factors associated with surgical outcomes.Methods: Pain reduction was analyzed in 14 patients with pudendal neuralgia who underwent transgluteal decompression and were followed for at least 12 months.Pain severity was assessed using the 11-point numerical rating scale (NRS-11), and percentage pain relief was calculated by comparing preoperative scores with those obtained at the last postoperative follow-up.Surgical success was defined as at least 50% pain reduction on the NRS-11.Subjective satisfaction was assessed using a 10-point Likert scale.The associations of demographic characteristics and variations in the sacrospinous ligamentectomy technique with surgical outcomes were also analyzed.Results: Transgluteal pudendal nerve decompression was successful in 12 of 14 patients (85.7%), and the mean percentage pain relief was 59.1 ± 20.4% at 23.9 ± 8.9 months postoperatively.Subjective improvement, assessed using the 10-point Likert scale, was 6.57 ± 2.47 at the final follow-up.None of the examined factors was significantly associated with the mean NRS-11 score, percentage pain relief, or subjective improvement (p > 0.05).Sacrospinous ligament resection was not associated with surgical outcome.Conclusion: Transgluteal pudendal nerve decompression provided pain relief in patients with chronic pudendal neuralgia.These observations raise questions about the need for routine sacrospinous ligament resection during pudendal nerve decompression surgery.