(031) UROLOGIC PATIENTS WITH GENITO-PELVIC DYSESTHESIA: EFFICACY OF TARLOV CYST SPINE SURGERY

Genito-Pelvic Dysesthesia (GPD), including chronic pelvic pain syndrome, is a common urologic disorder characterized by persistent, unwanted pain or discomfort (eg, arousal, burning, itching, pain, throbbing, urgency) in the genito-pelvic region including penis, clitoris, scrotum, vulva, urethra, prostate, bladder, vagina, and perineum. It is important for the urologist to appreciate that GPD can result from a pathology remote to the perceived location of symptoms, such as Tarlov cyst-induced sacral radiculopathy. Our objective was to evaluate, in urologic patients with GPD, long-term safety and efficacy of treatment with Tarlov cyst spine surgery.

Our objective was to evaluate, in urologic patients with GPD, long-term safety and efficacy of treatment with Tarlov cyst spine surgery.

Urologic patients with GPD diagnosed with Tarlov cyst-induced sacral radiculopathy referred for Tarlov cyst spine surgery between 2016 and 2023 were included. Treatment outcomes were based on responses on the validated Patient Global Impression of Improvement (PGI-I) scale at their most recent follow-up, 6 months or later.

Nineteen patients (6 men, 13 women), mean age 46 years (range 17-71) were included. Tarlov cyst surgery involved cyst excision and imbrication using computer-assisted navigation; patients were discharged the same day. There were no intra-operative complications. Mean follow-up was 18.2 months (range 6-43). 14 (74%) patients reported post-operative clinical improvement on PGI-I at last follow-up: 2 “very much better”, 9 “much better” and 3 “little better”. 5 patients had no improvement. No patient reported worsening of symptoms.

Spine surgery for Tarlov cyst-induced sacral radiculopathy was associated with clinical improvement in the majority of patients. To the best of our knowledge, this is the largest case series of patients with GPD treated by Tarlov cyst spine surgery. Urologists should be aware that their patients presenting with distressing GPD symptoms may have Tarlov cyst-induced sacral radiculopathy which can be successfully managed with Tarlov cyst surgery.

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