Bladder Pain Syndome/Interstitial Cystitis due to Pudendal Nerve Compression: Described in 1915—A Reminder for Treating Pelvic Pain a Century Later
20. Juni 2019
28. August 2019
06. März 2020 (online)
Background Interstitial cystitis (IC) or bladder pain syndrome (BPS) is highly painful and disabling and probably the most misdiagnosed urologic condition. Its classic symptoms of perineal pain, urinary urgency, and frequency despite sterile urine cultures were already described more than a century ago in a report on soldiers during World War (WW) I due to chronic pudendal nerve compression.
Objectives This article translates a report from 1915 on pudendal neuropathy and discusses its author Georg Zülzer (1870–1949).
Methods An English translation of the German original is provided with the biography and work of Zülzer, his clinical observations are discussed regarding modern diagnosis and therapy of pudendal nerve compression.
Results In his article entitled “Irritation of the Pudendal Nerve (Neuralgia). A Frequent Clinical Picture during War Feigning Bladder Catarrh,” Zülzer describes his observation of soldiers during WW I, presenting with a triad of perineal pain, urinary urgency, and frequency despite sterile urine cultures excluding urinary infections. He also documented a characteristic skin hypersensibility of the perineum in a rhomboid shape which corresponds to the innervation area of the pudendal nerve with its two branches deriving from the “pudendal plexus.” He regards this symptomology as rare during peace, but as disease of trench warfare which can be easily diagnosed regarding clear urine and a painful skin island overlying the area of the pudendal nerve as tested by simple needle examination. Zülzer, born in Germany, was forced to emigrate to the United States in 1934, was also an important pioneer of diabetes research using pancreas extracts from dogs as early as 1907.
Conclusion In this historical description, dating from about a century ago, Georg Zülzer probably gave the first exact clinical description of symptoms due to pudendal nerve compression. Pudendal nerve compression should always be taken into account when examining and treating patients with symptoms of IC/BPS.
- 1 Hanno PM, Erickson D, Moldwin R, Faraday MM. ; American Urological Association. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol 2015; 193 (05) 1545-1553
- 2 Zuelzer G. Reizung des Nervus pudendus (Neuralgie). Ein häufiges, Blasenkatarrh vortäuschendes Krankheitsbild im Kriege. Berlin Klin Wochenschr 1915; 52: 1260
- 3 Zuelzer G. Experimentelle Untersuchungen über den Diabetes. Berlin Klin Wochenschr 1907; 44: 474-475
- 4 Mellinghoff KH. [Georg Ludwig Zuelzer's contribution to the research on pancreatic extracts]. Med Welt 1972; 23 (16) 622-626
- 5 Hanno PM, Chapple CR, Cardozo LD. Bladder pain syndrome/interstitial cystitis: a sense of urgency. World J Urol 2009; 27 (06) 717-721
- 6 Baskin LS, Tanagho EA. Pelvic pain without pelvic organs. J Urol 1992; 147 (03) 683-686
- 7 Antolak Jr. SJ, Hough DM, Pawlina W, Spinner RJ. Anatomical basis of chronic pelvic pain syndrome: the ischial spine and pudendal nerve entrapment. Med Hypotheses 2002; 59 (03) 349-353
- 8 Dellon AL. Pain solutions. In: Pelvic Pain. Chapt. 12. Dellon Institutes for Peripheral Nerve Surgery; 2007. www.dellon.com/pain-solutions.html . Accessed September 17, 2019
- 9 Labat JJ, Riant T, Robert R, Amarenco G, Lefaucheur JP, Rigaud J. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn 2008; 27 (04) 306-310
- 10 Hruby S, Dellon L, Ebmer J, Höltl W, Aszmann OC. Sensory recovery after decompression of the distal pudendal nerve: anatomical review and quantitative neurosensory data of a prospective clinical study. Microsurgery 2009; 29 (04) 270-274
- 11 Antolak Jr. SJ, Antolak CM. Therapeutic pudendal nerve blocks using corticosteroids cure pelvic pain after failure of sacral neuromodulation. Pain Med 2009; 10 (01) 186-189
- 12 Hough DM, Wittenberg KH, Pawlina W. , et al. Chronic perineal pain caused by pudendal nerve entrapment: anatomy and CT-guided perineural injection technique. AJR Am J Roentgenol 2003; 181 (02) 561-567
- 13 Hruby S, Ebmer J, Dellon AL, Aszmann OC. Anatomy of pudendal nerve at urogenital diaphragm--new critical site for nerve entrapment. Urology 2005; 66 (05) 949-952
- 14 Dellon AL, Wright EJ, Manson PN. Chronic pelvic pain after laser prostatectomy: treatment by resection of the perineal branches of the pudendal nerve. J Reconstr Microsurg 2014; 30 (08) 547-550
- 15 Dellon AL, Coady D, Harris D. Pelvic pain of pudendal nerve origin: surgical outcomes and learning curve lessons. J Reconstr Microsurg 2015; 31 (04) 283-290
- 16 Wan EL, Dellon AL. Injury to the perineal branch of the pudendal nerve in men: Outcomes from surgical resection of the perineal branches. Microsurgery 2018; 38 (02) 172-176
- 17 Dellon AL, Coady D. Vulvar and pelvic pain terminology review: implications for microsurgeons. Microsurgery 2015; 35 (02) 85-90
- 18 Wan EL, Goldstein AT, Tolson H, Dellon AL. Injury to perineal branch of pudendal nerve in women: outcome from resection of the perineal branches. J Reconstr Microsurg 2017; 33 (06) 395-401