Anatomic Variations of the Pudendal Nerve within the Pelvis and Pudendal Canal with Clinical Applications

Abstract

published minimally important differences (MID) for utilities; thus, both would be considered preferred strategies. Multiple one-way sensitivity analyses confirmed robustness of results. The probability of having R1 preoperative event was lowest for No MBP (1%) vs. any MBPs [MgCit (40%), Fleets (70%), NaPhos (55%), and PEG (75%)]. The probability of having R1 intra-or postoperative complication was lowest with MgCit (6%) compared to No MBP (16%) and other MBPs [Fleets (12%), NaPhos (30%), and PEG (40%)]. Conclusion: The highest utilities were seen with No MBP and MgCit with the absolute difference less than the MID thus making both the preferred strategies. Not surprisingly, No MBP had by far the lowest incidence of preoperative events and complications while MgCit had the lowest intraor postoperative complications. Both had higher overall utility values compared to other MBP options. With similar overall utilities between these two, our model raises serious questions as to whether MBP is a necessary step prior to laparoscopic gynecologic surgery. However, if a surgeon prefers a bowel preparation, MgCit would be the preferred option.

Inferior gluteal and other nerves associated with sacrospinous ligament: a cadaver study

“…The neuroanatomy that is associated with the SSL has been described mainly from a transabdominal or pelvic approach. 4,7 These studies have emphasized the relationship of the pudendal nerve and vessels and that of the nerve to levator ani to the C-SSL complex. The inferior gluteal nerve (IGN) exits the pelvis between the piriformis muscle and C-SSL complex and supplies the gluteus maximus muscle and overlying skin.…”

Assessments of Pudendal Motor and Sensory Nerves in Patients with or without Fecal Incontinence after Low Anterior Resection for Lower Rectal Cancer

“…In patients with a narrow pelvis, especially male patients, close attention is necessary to avoid causing any mechanical damage in the anal canal while performing operative procedures. Fur-thermore, close attention is necessary when including anal canal tractions in a direction along the course of the pudendal nerve, which follows a path in the vicinity of the ischial spine [31] [33]. From the results of this study on the early postoperative status at 4 months after LAR, FI due to EAS dysfunction in LAR patients may be attributed to injuries of both the motor and sensory branches of the pudendal nerve.…”

“…PMN and PSN become gradually thiner from the anal to oral side in the anal canal. These two branches directly control EAS [32] [33]. Pfeifer et al [34] reported that anal sphincter stretching during anastomosis also injured PMN and PSN.…”

Role of nerve block as a diagnostic tool in pudendal nerve entrapment

“…This has resulted in the condition being frequently misdiagnosed and inappropriately treated . However, recent studies have established PNE as the primary aetiology in pudendal neuralgia . This presents an opportunity for cure of this frequently disabling condition.…”

“…The dorsal nerve of the clitoris/penis extends along the dorsum of these organs, supplying the overlying skin . Cadaveric studies since 1987 have delineated the three main sites of pudendal nerve compression: (i) between the sacrotuberal and sacrospinous ligaments; (ii) within Alcock's canal; and (iii) when crossing the falciform process of the sacrotuberal ligament . This knowledge has enabled refined surgical decompression techniques which yield success rates of 53–83% …”