Pelvic Pain of Pudendal Nerve Origin: Surgical Outcomes and Learning Curve Lessons

Reconstructive microsurgery may directly involve the puden-dal nerve during vaginal reconstruction,1–4 groin hydradenitis suppurativa reconstruction,5,6 rectal reconstruction,7–9 trans-gender reconstruction,10–12 inferior gluteal artery perforator flaps for breast reconstruction,13–16 labial reconstruction,17–19 salvage procedures after gynecologic mesh interventions for urinary incontinence,20–22 and following urologic procedures such as prostatectomy.23,24 Injury to the branches of the pudendal nerve results in pain syndromes that have proven difficult to treat, with success rates for the most commonly done surgical approach having an expectation that 70 % of patients will improve by> 2 on a 10-point Likert scale, and just 20 % achieving an excellent result (►Table 1).25–32 Recognizing that peripheral nerve surgery is the basis for treatment of refractory pelvic pain related to the pudendal