Perineural dextrose injections in the treatment of lower urinary tract symptoms and dyspareunia induced by obturator neuralgia

Obturator neuralgia is commonly diagnosed and treated in orthopedics. It produces groin pain, sensory alteration in the medial thigh (dysesthesia, sensory loss, or pain), adductor muscle weakness and pain/restriction of hip movements. Basically, the clinical diagnosis of obturator neuralgia is made by producing pain during internal rotation of the hip against resistance ("obturator sign") or by extension and lateral leg movements. We postulate obturator neuralgia can induce lower urinary tract symptoms and dyspareunia and be diagnosed by using three clinical signs characterizing neuralgia everywhere on the body: painful nerve trunk (at the entrance of the obturator canal; by vaginal or rectal examination), abnormal sensibility and painful skin rolling test in its cutaneous innervation territory (inferomedial skin of the thigh). To support our assumptions, three female patients with longstanding lower urinary tract symptoms and/or dyspareunia and a clinical examination suggestive of obturator neuralgia (three clinical signs positive) were treated by perineural injections of dextrose 5% in sterile water (D5W). The three patients were clinically improved or cured after the treatment with two of them being cured after a single injection. While waiting for confirmation of these findings by randomized controlled trials, we suggest that obturator neuralgia should be sought in every patient with lower urinary tract symptoms and/or dyspareunia and that obturator perineural D5W injections be tried to relieve these patients.

Keywords: Dextrose injections; Dyspareunia; Obturator neuralgia; Painful bladder; Painful nerve trunk; Pelvic floor muscular trigger points; Perineology; Pudendal neuralgia; Skin rolling test; Urge incontinence.