Abstract
<title>Abstract</title> <p>Background Pudendal nerve entrapment (PNE) is an underrecognized cause of chronic pelvic pain frequently associated with urinary and sexual dysfunction. Current treatment strategies are largely empirical, and evidence supporting pharmacologic therapies remains limited. Given the neurovascular and anti-inflammatory properties of phosphodiesterase type-5 (PDE5) inhibitors, the objective of this study is to evaluate the effect of daily Tadalafil on pain, erectile function, urinary symptoms, and quality of life (QoL) in men with PNE and erectile dysfunction (ED) Methods A prospective exploratory study was conducted in men diagnosed with PNE and ED. Participants received daily Tadalafil and were evaluated at baseline, one month, and three months. The primary endpoint was change in pain intensity measured by the visual analogue scale (VAS). Secondary endpoints included evaluation of erectile function, urinary symptoms and QoL. Results Thirty men were included, with a median age of 37.1 years. Mean baseline VAS score decreased significantly from 7.2 to 3.7 at one month and 3.4 at three months (p-value < 0.001). Mean International Index of Erectile Function-5 score improved from 14.0 at baseline to 20.0 at one month and 21.0 at three months (p-value < 0.001). Mean International Prostate Symptom Score decreased from 17.4 at baseline to 12.9 at one month and 13.2 at three months (p-value < 0.001). QoL score also improved significantly over time. Conclusion In this cohort, pain score, erectile function and urinary symptoms were improved over three months of daily Tadalafil in men with PNE and ED. While the open-label design and lack of a control group render these findings hypothesis-generating, PDE5 inhibitors may represent a promising therapeutic option in this population, necessitating confirmation via a randomized controlled trial.</p>