Different Transcutaneous Electrical Nerve Stimulation Modes in Pudendal Neuralgia Post-prostatectomy

Abstract

Purpose: This study aimed to evaluate the efficacy of Different Transcutaneous Electrical Nerve Stimulation Modes in Pudendal Neuralgia Post-prostatectomy. Methods of evaluation (Elexcess twenty ten device for blood serum analysis for the measurement of serum cortisol level, Visual analogue scale (VAS) to assess degree of pain severity and Estimation of the Carbamazepin Intake: (CMI): to evaluate the improvement in the chronic pudendal neuralgia post-prostatectomy and its intractable perineal pain Methods: Sixty male patients suffering from chronic pudendal neuralgia post-prostatectomy from out-clinics of the general surgery department in Om-El Misrieen hospital, were participated in this study. Their ages ranged from 50 to 60 years old. Those patients had chronic pudendal neuralgia that may be associated with pelvic surgery, strenuous exercise, abnormalities of the sacroiliac joint, and may be connected to age-related changes that confirmed by physical exam, reproduction of pain with digital rectal examination, pressure at the level of the left ischial spine and positional nature of the pain and relief when sitting on a lavatory seat. Also, diagnosis was validated via the nerve conduction studies, using an intrarectal technique to measure the distal motor latency that objectively confirmed the diagnosis. They were assigned randomly into two groups; the first study group (A) was composed of 30 patients who received the conventional TENS in addition to the traditional physical therapy and medical care for 3 months. The second study group (B), that was composed of 30 patients who received the SLR acupuncture- TENS application in addition to the traditional physical therapy and medical care for 3 months Methods: Sixty male patients aged 50–60 years with chronic pudendal neuralgia post-prostatectomy were enrolled from the outpatient clinics of the General Surgery Department at Om-El Misrieen Hospital. Patients suffered from pain reproduction via digital rectal examination, pressure sensitivity at the left ischial spine, and positional pain relief when seated on a lavatory seat. Nerve conduction studies using an intrarectal technique to measure distal motor latency further validated the diagnosis. Participants were randomly assigned to two groups; the first study group (A) was composed of 30 patients who received the conventional TENS in addition to the traditional physical therapy and medical care for 3 months. The second study group (B), that was composed of 30 patients who received the SLR acupuncture- TENS application in addition to the traditional physical therapy and medical care for 3 months. Measuring outcome: Serum Cortisol Level (SCL) was measured using the Elexcess Twenty Ten device, pain was measured using visual Analogue Scale (VAS), and carbamazepine intake (CMI) was monitored to evaluate pharmacological dependence and symptom improvement. Results: Both TENS modalities produced statistically significant reductions in SCL, VAS scores, and CMI, indicating effective pain relief. However, Acupuncture-like TENS demonstrated is more effective than conventional TENS. Conclusion: Acupuncture-like TENS is more effective than Conventional TENS in alleviating chronic pudendal neuralgia and associated perineal pain following prostatectomy.