The Nantes Criteria

Diagnostic criteria for pudendal neuralgia by

pudendal nerve entrapment

(the Nantes criteria)

Jean-Jacques Labat , Thibault Riant, Roger Robert, Gérard Amarenco, Jean-Pascal Lefaucheur, Jérôme Rigaud

Affiliation

Service d'Urologie, CHU Hôtel-Dieu, Nantes, France

PMID: 17828787 DOI: 10.1002/nau.20505
Published by Wiley-Liss, Inc. 2007

Abstract

Aims: The diagnosis of pudendal neuralgia by pudendal nerve entrapment syndrome is essentially clinical. There are no pathognomonic criteria, but various clinical features can be suggestive of the diagnosis. We defined criteria that can help to the diagnosis.

Materials and methods: A working party has validated a set of simple diagnostic criteria (The Nantes criteria).

Results: The Five Essentials Diagnostic Criteria are:

(1) Pain in the anatomical territory of the pudendal nerve.

(2) Worsened by sitting.

(3) The patient is not woken at night by the pain.

(4) No objective sensory loss on clinical examination (physical exam)

(5) Positive Diagnostic Anesthetic Pudendal Nerve Block 2 (PNA recommends transgluteal approach)

Other clinical criteria can provide additional arguments in favor of the diagnosis of pudendal neuralgia. Exclusion criteria are also proposed: purely coccygeal, gluteal, or hypogastric pain, exclusively paroxysmal pain, exclusive pruritus, presence of imaging abnormalities able to explain the symptoms.

Conclusion: The diagnosis of pudendal neuralgia by pudendal nerve entrapment syndrome is essentially clinical. There are no specific clinical signs or complementary test results of this disease. However, a combination of criteria can be suggestive of the diagnosis.

PNA Note: Most U.S. physicians include a steroid injection (usually Kenalog/triamcinolone) in spite of a 2016 randomized double-blind trial in Nantes, France, that concluded steroids offer "no therapeutic benefit" for pudendal neuralgia. The study is now eight years old. We do not understand why physicians continue this practice and instead follow the science as European doctors do. Steroids always carry risk, we recommend printing the trial using the URL and bringing it to you appointment and request that no steroids be included in what is a purely diagnostic anesthetic block.

1. Link to Willey-Liss, Inc. scholarly publication Nantes Criteria 2007: https://pubmed.ncbi.nlm.nih.gov/17828787/

2 Link to Willey-Liss, Inc scholarly publication Steroids Trial 2016 (jpg below): https://pubmed.ncbi.nlm.nih.gov/27465823/

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