The incidence of urinary symptoms among patients diagnosed with pudendal neuralgia has not been sufficiently explored yet, as well as the role of the urodynamic testing. 
This study aimed to determine the frequency of urinary symptoms in these patients and to examine the role of urodynamic studies in the evaluation of pudendal neuralgia.

We conducted a retrospective study of patients who were diagnosed with pudendal neuralgia from January 2012 to June 2020. All of them were evaluated following a protocol that included medical records, Nantes criteria’s questionnaire, VAS pain score, validated three days bladder diary, physical examination, imaging studies, neurophysiological and urodynamic tests. All patients met the clinical essential Nantes criteria: (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

52 patients were included in this study. 45/52 were females (86.54%) and the mean age was 51.17 (SD 14.15) years. 32 (61.54%) patients reported urinary symptoms, 20 out of them (38.46%) urgency and 14 (26.92%) urgency urinary incontinence. 

Urodynamic tests were performed in 46 participants. 16 of them (34.78%) had pathological findings. The most common urodynamic finding was detrusor hypocontractility (56.25%), followed by bladder outlet obstruction (18.75%) (table 1).

75.5% of patients with pudendal neuralgia have urinary symptoms, urodynamic findings, or both (diagram 1).

It should be acknowledged that urodynamic testing has shortcomings and pitfalls. The interpretation can only be done properly after education, training, and expertise. 
Three in four patients with pudendal neuralgia have urinary symptoms. Urodynamic testing provides objective measures of the function of the lower urinary tract.
With this data we can assess that urodynamics is an important tool in the assess the generators of chronic pelvic pain. 
It is universally accepted by urologists and gynecologists, who rarely use urodynamic testing in the evaluation of chronic pelvic pain. Unfortunately, many pain specialists, anesthesiologists, and neurologists are only beginning to develop familiarity with this modality. An innovative approach to the use of urodynamic testing (including pudendal neurophisiology test and anorectal manometry) promises to advance the diagnosis and assessment of a wide variety of painful syndromes involving the genitourinary system, pelvis, the lower bowel, and even the lower spine.

Besides pelvic pain, other associated symptoms, mainly urinary symptoms, should be considered as an essential part of evaluation of patients with pudendal neuralgia, because of their frequency. Furthermore, urodynamic testing should be used to screen chronic pelvic pain dysfunctions.