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Zapletal J, Nanka O, Halaska MJ, Maxova K, Hajkova Hympanova L, Krofta L, Rob L. Anatomy of the pudendal nerve in clinically important areas: a pictorial essay and narrative review. Surg Radiol Anat 2024; 46:211-222. [PMID: 38240796 DOI: 10.1007/s00276-023-03285-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/14/2023] [Indexed: 02/15/2024]
Abstract
PURPOSE The pudendal nerve is an anatomical structure arising from the ventral branches of the spinal roots S2-S4. Its complex course may be affected by surrounding structures. This may result in irritation or entrapment of the nerve with subsequent clinical symptoms. Aim of this study is to review the anatomy of the pudendal nerve and to provide detailed photographic documentation of the areas with most frequent clinical impact which are essential for surgical approach. METHODS Major medical databases were searched to identify all anatomical studies investigating pudendal nerve and its variability, and possible clinical outcome of these variants. Extracted data consisted of morphometric parameters, arrangement of the pudendal nerve at the level of roots, formation of pudendal nerve, position according to sacrospinal and sacrotuberal ligaments and its terminal branches. One female cadaver hemipelvis was dissected with common variability of separate course of inferior rectal nerve. During dissection photodocumentation was made to record course of pudendal nerve with focus on areas with recorded pathologies and areas exposed to iatrogenic damage during surgical procedures. RESULTS Narrative review was done to provide background for photodocumentation. Unique photos of course of the pudendal nerve was made in areas with great clinical significance. CONCLUSION Knowledge of anatomical variations and course of the pudendal nerve is important for examinations and surgical interventions. Surgically exposed areas may become a site for iatrogenic damage of pudendal nerve; therefore, unique picture was made to clarify topographic relations.
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Affiliation(s)
- Jan Zapletal
- Department of Obstetrics and Gynaecology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Srobarova 1150/50, 100 34, Prague 10, Czech Republic.
| | - O Nanka
- Institute of Anatomy, First Faculty of Medicine, Charles University, U Nemocnice 3, 128 00, Prague 2, Czech Republic
| | - M J Halaska
- Department of Obstetrics and Gynaecology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Srobarova 1150/50, 100 34, Prague 10, Czech Republic
| | - K Maxova
- Department of Obstetrics and Gynaecology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Srobarova 1150/50, 100 34, Prague 10, Czech Republic
| | - L Hajkova Hympanova
- Institute for the Care of Mother and Child Prague, Third Faculty of Medicine, Charles University, Podolske nabrezi 157, 147 00, Prague, Czech Republic
| | - L Krofta
- Institute for the Care of Mother and Child Prague, Third Faculty of Medicine, Charles University, Podolske nabrezi 157, 147 00, Prague, Czech Republic
| | - L Rob
- Department of Obstetrics and Gynaecology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Srobarova 1150/50, 100 34, Prague 10, Czech Republic
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Lam CM, Keim SA, Latif U. Novel implantation technique for pudendal nerve peripheral nerve stimulation for treatment of chronic pelvic pain. Reg Anesth Pain Med 2023; 48:567-571. [PMID: 37419506 DOI: 10.1136/rapm-2023-104551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/23/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Chronic pelvic pain (CPP) is a pervasive, difficult to treat condition affecting up to 26% of the global female and 8.2% of the global male population. Considered a form of chronic regional pain syndrome (CRPS), it is medically complex and often refractory to multimodal management. Neuromodulation has become increasingly popular in treatment of chronic neuropathic pain conditions, including CPP and CRPS. Dorsal column spinal cord stimulation and dorsal root ganglion stimulation have had some success for managing CPP meanwhile peripheral nerve stimulators (PNS) have been suggested as another viable option. However, few studies in the literature have reported successful use of PNS in treatment of CPP. Here, we detail a possible technique for pudendal PNS lead placement for management of CPP. METHOD This article describes a novel cephalad to caudad fluoroscopic guided technique for pudendal nerve PNS lead placement and implantation. RESULTS A cephalad to caudal-medial fluoroscopic guided approach as described within to successfully implant a percutaneous pudendal nerve PNS for management of CPP. CONCLUSIONS The pudendal nerve PNS lead placement technique noted within can be used to avoid many of the important neurovascular structures near the pelvic outlet. Further studies are needed to validate the safety and efficacy of this therapy modality but it may be a viable management option for patients with medically refractory CPP.
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Affiliation(s)
- Christopher M Lam
- Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sarah A Keim
- Department of Surgery, University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Usman Latif
- Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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Ranjan R, Chanda C, Kushwaha R, Nag AR. Anatomical Study of the Variants of Extrapelvic Part of the Pudendal Nerve. Cureus 2022; 14:e28281. [PMID: 36158338 PMCID: PMC9492552 DOI: 10.7759/cureus.28281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/09/2022] Open
Abstract
Background A comprehensive understanding of the anatomy of the extra pelvic course of the pudendal nerve and its variations is crucial when undertaking perineal and perirectal procedures to safeguard the integrity of the extrapelvic segment of the pudendal nerve and its branches. So we aimed to identify the changes in the pudendal nerve's extrapelvic branching pattern before it enters the pudendal canal and its relationships and connections. Materials and Methods A cross-sectional descriptive study was carried out on 26 formalin embalmed adult human cadavers between 20 to 65 years (16 male and 10 female) of north Indian origin. Anatomical course, variations, and connections of the pudendal nerve before entering the pudendal canal were noted. Results The extrapelvic course of the pudendal nerve was examined in 52 hemipelves (26 cadavers) after meticulous dissection. Single pudendal nerve trunk (type I) was identified in 51.9% of hemipelves. Two trunked pudendal nerve with inferior gluteal nerve piercing the sacrospinous ligament (type IIa) was observed in 13.5% of hemipelves. 23.1% of hemipelves exhibited two trunked pudendal nerves with inferior gluteal nerve not piercing the sacrospinous ligament(type IIb). Three trunked pudendal nerve (type III) was observed in 11.5% of hemipelves. In 14/52 hemipelves (26.9%), communication with the sciatic nerve was noted, whereas, in 38/52 hemipelves (73.1%), no communication with the sciatic nerve was present. Conclusion The extrapelvic course of the pudendal nerve may present with an earlier subdivision or even an aberrant connection with the sciatic nerve. These anatomical variations of the extra pelvic course of the pudendal nerve, its variations, and connections are essential for all surgeons and anesthetists operating in the perineal and perirectal region to avoid unwanted complications.
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Gu Y, Lv T, Jiang C, Lv J. Neuromodulation of the Pudendal Nerve Assisted by 3D Printed: A New Method of Neuromodulation for Lower Urinary Tract Dysfunction. Front Neurosci 2021; 15:619672. [PMID: 33716649 PMCID: PMC7952533 DOI: 10.3389/fnins.2021.619672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/05/2021] [Indexed: 11/18/2022] Open
Abstract
Electrical stimulation of peripheral nerves by implanted electrodes is an effective treatment for certain pelvic floor diseases. As well as intravesical electrical stimulation, this predominantly includes stimulation of the sacral nerve, tibial nerve, and pudendal nerve. The pudendal nerve is one of the main nerves that stimulate pelvic floor muscles, external urethral meatus, and the anal sphincter and pelvic organs, and it may have effects on frequent urination, urgency, dysuria, and perineal pain. It is difficult to locate because of its anatomical course, however, leading to difficulties fixing the electrode, which increases the difficulty of pudendal nerve electrical stimulation in clinical practice. In the current study 3D printed navigation was used to solve these problems. Combined with autopsy data and patient pelvic and nerve data, a personalized design was generated. Neural modulation of the pudendal nerve was achieved by implanting the lead with the guidance of 3D printed navigation. 3D printed navigation can maximize the phase II conversion rate, reduce the difficulty of surgery, shorten the operation time, reduce damage to additional organs and blood vessels, and increase the accuracy of electrode implantation, and it can be performed while the patient is awake. It is an accurate, reversible, efficient, and minimally invasive surgery.
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Affiliation(s)
- Yinjun Gu
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingting Lv
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Jiang
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianwei Lv
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wijsmuller AR, Giraudeau C, Leroy J, Kleinrensink GJ, Rociu E, Romagnolo LG, Melani AGF, Agnus V, Diana M, Soler L, Dallemagne B, Marescaux J, Mutter D. A step towards stereotactic navigation during pelvic surgery: 3D nerve topography. Surg Endosc 2018; 32:3582-3591. [PMID: 29435745 PMCID: PMC6061054 DOI: 10.1007/s00464-018-6086-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 02/01/2018] [Indexed: 12/28/2022]
Abstract
Background Long-term morbidity after multimodal treatment for rectal cancer is suggested to be mainly made up by nerve-injury-related dysfunctions. Stereotactic navigation for rectal surgery was shown to be feasible and will be facilitated by highlighting structures at risk of iatrogenic damage. The aim of this study was to investigate the ability to make a 3D map of the pelvic nerves with magnetic resonance imaging (MRI). Methods A systematic review was performed to identify a main positional reference for each pelvic nerve and plexus. The nerves were manually delineated in 20 volunteers who were scanned with a 3-T MRI. The nerve identifiability rate and the likelihood of nerve identification correctness were determined. Results The analysis included 61 studies on pelvic nerve anatomy. A main positional reference was defined for each nerve. On MRI, the sacral nerves, the lumbosacral plexus, and the obturator nerve could be identified bilaterally in all volunteers. The sympathetic trunk could be identified in 19 of 20 volunteers bilaterally (95%). The superior hypogastric plexus, the hypogastric nerve, and the inferior hypogastric plexus could be identified bilaterally in 14 (70%), 16 (80%), and 14 (70%) of the 20 volunteers, respectively. The pudendal nerve could be identified in 17 (85%) volunteers on the right side and in 13 (65%) volunteers on the left side. The levator ani nerve could be identified in only a few volunteers. Except for the levator ani nerve, the radiologist and the anatomist agreed that the delineated nerve depicted the correct nerve in 100% of the cases. Conclusion Pelvic nerves at risk of injury are usually visible on high-resolution MRI with dedicated scanning protocols. A specific knowledge of their course and its application in stereotactic navigation is suggested to improve quality of life by decreasing the likelihood of nerve injury. Electronic supplementary material The online version of this article (10.1007/s00464-018-6086-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A R Wijsmuller
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands. .,IRCAD/ EITS, Department of General, Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France.
| | - C Giraudeau
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - J Leroy
- Department of Digestive Colorectal Minimally Invasive Surgery, Hanoi High Tech and Digestive Center, Saint Paul Hospital, Hanoi, Vietnam
| | - G J Kleinrensink
- Department of Neurosciences, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E Rociu
- Department of Radiology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | - L G Romagnolo
- IRCAD Latin America, Department of Surgery, Barretos Cancer Center, Barretos, Brazil
| | - A G F Melani
- IRCAD Latin America, Department of Surgery, Barretos Cancer Center, Barretos, Brazil.,Americas Medical City, Rio de Janeiro, Brazil.,IRCAD Latin America, Rio de Janeiro, Brazil
| | - V Agnus
- IRCAD/ EITS, Department of General, Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
| | - M Diana
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - L Soler
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - B Dallemagne
- IRCAD/ EITS, Department of General, Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
| | - J Marescaux
- IRCAD/ EITS, Department of General, Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
| | - D Mutter
- IRCAD/ EITS, Department of General, Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
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Maldonado PA, Chin K, Garcia AA, Corton MM. Anatomic variations of pudendal nerve within pelvis and pudendal canal: clinical applications. Am J Obstet Gynecol 2015; 213:727.e1-6. [PMID: 26070708 DOI: 10.1016/j.ajog.2015.06.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/28/2015] [Accepted: 06/02/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of the study was to examine the anatomic variation of the pudendal nerve in the pelvis, on the dorsal surface of the sacrospinous ligament, and in the pudendal canal. STUDY DESIGN Detailed dissections of the pudendal nerve were performed in unembalmed female cadavers. Pelvic measurements included the distance from the origin of the pudendal nerve to the tip of ischial spine and the nerve width at its origin. The length of the pudendal canal was measured. The inferior rectal nerve was identified in the ischioanal fossa and its course documented. Lastly, the relationship of the pudendal nerve to the dorsal surface of the sacrospinous ligament was examined after transecting the lateral surface of the sacrospinous ligament. Descriptive statistics were used for data analyses and reporting. RESULTS Thirteen female cadavers (26 hemipelvises) were examined. A single pudendal nerve trunk was identified in 61.5% of hemipelvises. The median distance from the point of the pudendal nerve formation to the ischial spine was 27.5 mm (range, 14.5-37 mm). The width of the pudendal nerve in the pelvis was 4.5 mm (range, 2.5-6.3 mm). The length of the pudendal canal was 40.5 mm (range, 20.5-54.5 mm). The inferior rectal nerve was noted to enter the pudendal canal in 42.3% of hemipelvises; in these cases, the nerve exited the canal at a distance of 32.5 mm (range, 16-45 mm) from the ischial spine. In the remaining specimens, the inferior rectal nerve passed behind the sacrospinous ligament and entered the ischioanal fossa without entering the pudendal canal. In all specimens, the pudendal nerve was fixed by connective tissue to the dorsal surface of the sacrospinous ligament. CONCLUSION Great variability exists in pudendal nerve anatomy. Fixation of the pudendal nerve to the dorsal surface of the sacrospinous ligament is a consistent finding; thus, pudendal neuralgia attributed to nerve entrapment may be overestimated. The path of the inferior rectal nerve relative to the pudendal canal may have implications in the development of anorectal symptoms. Improved characterization of the pudendal nerve and its branches can help avoid intraoperative complications and enhance existing treatment modalities for pudendal neuropathy.
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Affiliation(s)
- Pedro A Maldonado
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Kathleen Chin
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alyson A Garcia
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Marlene M Corton
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
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van der Walt S, Oettlé AC, van Wijk FJ. The Pudendal Nerve and Its Branches in Relation to Richter's Procedure. Gynecol Obstet Invest 2015; 81:275-9. [PMID: 26227418 DOI: 10.1159/000435878] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 06/11/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Variations in the branching pattern of the pudendal nerve (PN) have been described in the literature. This study investigated these variations in order to comment on a safe area for the placement of a Richter's stitch. METHODS Richter's procedure was performed on nine unembalmed female cadavers and followed by dissection. PN dissections were done on another 20 embalmed female cadavers. Variations in the branching pattern of the PN were noted and the distance between the Richter's stitch placed and the PN/or the inferior rectal nerve (IRN) measured. RESULTS The IRN entered the gluteal region as a separate structure in 6/29 cases. The separate IRN was found to pass between 4.1 and 14.45 mm medial to the ischial spine in 18/29 cases. In one case, the Richter's stitch was found to pierce the IRN. The distance between the stitch and the PN and/or the IRN ranged from 0 to 17.8 mm. CONCLUSIONS To minimize the risk of nerve damage or entrapment, the Richter's stitch should be placed >20 mm from the ischial spine. This recommended area should be revised for different population groups, as variations might exist between groups.
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Affiliation(s)
- Sonè van der Walt
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Abstract
The pudendal nerve is located topographically in areas in which plastic surgeon reconstruct the penis, the vagina, the perineum, and the rectum. This nerve is at risk for either compression or direct injury with neuroma formation from obstetrical, urogynecologic, and rectal surgery as well as pelvic fracture and blunt trauma. The purpose of this study was to create a 3-dimensional representation based on magnetic resonance imaging of the pelvis supplemented with new anatomic dissections in men and women to delineate the location of the pudendal nerve and its branches, providing educational information both for surgical intervention and patient education. The results of this study demonstrated that most often there are at least 2, not 1, "pudendal nerves trunks" as they leave the pelvis to transverse the sacrotuberous ligament, and that there are most often 2, not 1, exit(s) from Alcock canal, one for the dorsal branch and one for the perineal branch of the pudendal nerve.
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van der Walt S, Oettlé AC, Patel HRH. Surgical anatomy of the pudendal nerve and its branches in South Africans. Int J Impot Res 2015; 27:128-32. [DOI: 10.1038/ijir.2015.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 02/23/2015] [Accepted: 04/25/2015] [Indexed: 11/09/2022]
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Prologo JD, Lin RC, Williams R, Corn D. Percutaneous CT-guided cryoablation for the treatment of refractory pudendal neuralgia. Skeletal Radiol 2015; 44:709-14. [PMID: 25511935 DOI: 10.1007/s00256-014-2075-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/25/2014] [Accepted: 11/26/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of percutaneous CT-guided cryoablation of the pudendal nerve for the treatment of refractory pudendal neuralgia. MATERIALS AND METHODS Eleven patients were selected to undergo percutaneous CT-guided cryoablation of the pudendal nerve based on established diagnostic criteria. Brief Pain Inventory questionnaires were administered prior to the procedure, during the immediate 24 h post procedure, and 45 days and 6 months following the procedure. RESULTS Prior to treatment, the average level of pain on a scale from 0 (no pain) to 10 (worst pain imaginable) was 7.6, with pain described as "burning" (80%), "pulling" (37.5%), "crushing" (50%), "pressure" (84.5%), "throbbing" (50%), "knife-life" (52%), and "other" (60%). At 24 h, 45 days, and 6 months post-treatment, pain intensity dropped to 2.6, 3.5, and 3.1, respectively (p < 0.005). There were no procedure-related complications. CONCLUSIONS CT-guided percutaneous cryoablation may represent a safe and efficacious option for selected patients with refractory pudendal neuralgia.
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Affiliation(s)
- J David Prologo
- Department of Radiology and Imaging Sciences Division of Interventional Radiology and Image-Guided Medicine, Emory University Hospital, 1364 Clifton Road, NE Suite D112, Atlanta, GA, 30322, USA,
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Anatomical basis of transgluteal approach for pudendal neuralgia and operative technique. Surg Radiol Anat 2013; 35:609-14. [PMID: 23455364 DOI: 10.1007/s00276-013-1092-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Pudendal neuralgia is an entrapment syndrome whose both anatomic landmarks and operative technique remain relatively unfamiliar to neurosurgeons. OBJECTIVE To provide an outline of operative steps that is important to correct application of this approach. METHODS Surgical illustrations are included. The different figures detail the important steps of the operation. RESULTS We perform a transmuscular approach leading to the sacrotuberous ligament, which is opened sagittally. The pudendal nerve and internal pudendal artery are found to be enclosed by a fascia sheath. The pudendal nerve swings around the sacrospinous ligament sacrospinous ligament with tension. Both distal branches of the pudendal nerve can be followed, especially the rectal branch running medially. After the section of the sacrospinous ligament, the pudendal nerve can be transposed frontally to the ischial spine within the ischiorectal fat. During this maneuver, significant venous bleeding may be encountered as perineural satellite veins dilatation can accompany or surround the pudendal nerve. It is important to avoid overpacking to limit compression injury to the pudendal nerve using judiciously small pieces of hemostatic device and soft cottonoid with light pressure. Then, the obturator fascia and the membranous falciform process of the sacrotuberous ligament that extend toward the ischioanal fossa must be incised. CONCLUSION Transgluteal approach is a safe technique and we demonstrate that this approach can be performed safely minimizing pain, size of incision, surgical corridor, and trauma to adjacent muscles of buttock.
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Matejčík V. Surgical location and anatomical variations of pudendal nerve. ANZ J Surg 2012; 82:935-8. [DOI: 10.1111/j.1445-2197.2012.06272.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Viktor Matejčík
- Department of Neurosurgery; Medical Faculty; Comenius University; Bratislava; Slovak Republic
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Pudendal Nerve Neuromodulation: A New Option for Refractory Bladder Overactivity and Pain. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-010-0052-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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