Anatomy of pudendal nerve at urogenital diaphragm—new critical site for nerve entrapment

Hruby, Stephan; Ebmer, Johannes; Dellon, A. Lee; Aszmann, Oskar C.

doi:10.1016/j.urology.2005.05.032

Cited by 60 publications

(33 citation statements)

References 22 publications

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“…Knowledge of the pudendal nerve variations is important for clinics (19,21). In the prefi xed type, the nerve roots receive more fi laments from above-located spinal nerves.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of nervus pudendus

Matejcik¹,

Štěňo²,

Haviarová³

2013

BLL

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An objective of our work was to clarify variations in pudendal nerve formation, as well as their possible impact on the clinical picture. Bilateral pudendal nerve course and formation was studied on 20 adult cadavers. Anterior approach was used in 15 of them, both posterior and anterior approaches were used in fi ve of them. The prefi xed type plexus formation was observed in eight cases (40 %). In these cases S 1 , S 2 roots contributed to the formation of the pudendal nerve. In the postfi xed type particularly the S 3 root was dominant in two cases (66.7 %), and less the S 4 root in one case (23.3 %) from three cases. Mostly the S 2 root participated in its formation in 17 cases (85 %). The pudendal nerve branches run below the sacrospinous ligament on the level of the sacrospinous and sacrotuberous ligaments. The changes of the nerve and the branching therof were most evident from the anterior access below the sacrospinous ligament and in front of the sacrotuberous ligament. The inferior rectal nerve penetrating the sacrospinous ligament was seen in one case, it has risen from the pudendal nerve before entering the pudendal canal in four cases. The dorsal nerve of the penis has risen from the S 1 root in two cases (10 %). We observed its branching before entering the pudendal canal in 15 cases (75 %). It has divided in the pudendal canal in other cases. This description may be useful particularly for the pudendal nerve block and the nerve saving surgeries directed on the relevant region (Fig. 8 The pudendal nerve is one of the sacral plexus branches; originating from the anterior branches of S 2 to S 4 sacral nerves. It is the sensory and motor nerve of the perineum, innervating the external anal sphincter, urethral sphincter, perineal muscles and the skin (1-5).The main trunk of the pudendal nerve is formed proximally to the ischial spine, and medially and caudally to the sciatic nerve. It runs between the piriformis and coccygeus, medially to the pudendal vessels. Branches for the levator ani and coccygeus leave the pudendal nerve at the inferior margin of the piriformis. It then continues into the gluteal area through the greater sciatic foramen, and enters the pudendal canal through the lesser sciatic foramen.It runs behind the sacrospinous ligament and in front of the sacrotuberous ligament, then continues ventrocaudally into the perineal area, where it enters the pudendal canal (Alcock) formed by divided fascia of obturatorius internus. During its course it gives off inferior anal nerves and inferior rectal nerves respectively, which rise from the pudendal nerve just before entering the pudendal canal, or leave the pudendal canal and enter the proximal part of ischiorectal fossa; then they run through the fat and innervate the external anal sphincter and the skin around the anus (4, 5). Approximately in the centre of the pudendal canal it bifurcates into two branches -the perineal nerves and the dorsal nerve of the penis/clitoris. The perineal nerves serve for sensitive skin innervation of the...

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“…Knowledge of the pudendal nerve variations is important for clinics (19,21). In the prefi xed type, the nerve roots receive more fi laments from above-located spinal nerves.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of nervus pudendus

Matejcik¹,

Štěňo²,

Haviarová³

2013

BLL

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“…Its average length is about 3 cm and, as a sign of entrapment, a pseudoneuroma was found in two of the 10 specimen. 5 Recently, Sedy et al reported a similar narrowing. They termed it the ''Sulcus Nervi dorsalis'' and also described it in women.…”

mentioning

confidence: 82%

Sensory recovery after decompression of the distal pudendal nerve: Anatomical review and quantitative neurosensory data of a prospective clinical study

et al. 2009

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The distal pudendal nerve is susceptible to compression at the passage from Alcocks canal to the dorsum of the penis. Diabetic patients with peripheral neuropathy can suffer from additional compression neuropathy with decreased penile sensibility and dysaesthesia. One-point pressure threshold testing proved to be a sensitive parameter in the diagnosis and finally, patients would benefit from decompression of the pudendal nerve.

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“…The terminal branch of the pudendal nerve includes the dorsal nerve of the penis and clitoris. 64 The pudendal and genitofemoral nerves, as well as branches of the iliohypogastric and ilioinguinal nerves, innervate the symphysis pubis. 59 The pelvic, hypogastric and pudendal nerves also carry sensory information in afferent fibers from the lower urinary tract to the lumbosacral spinal cord.…”

Section: Clinical Evidence For a Spinal Origin Of Urinary Bladder Dysmentioning

confidence: 99%

Chiropractic Management of Pubic Symphysis Shear Dysfunction in a Patient With Overactive Bladder

Cooperstein

Lisi

Burd

2014

Journal of Chiropractic Medicine

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Objective: The purpose of this case report is to describe chiropractic management of a patient with overactive bladder (OAB) and to describe an hypothetical anatomical basis for a somatovesical reflex and possible clinical link between pelvic and symphysis pubis dysfunction to OAB. Clinical features: A 24-year-old nulliparous female with idiopathic OAB, with a primary complaint of nocturia presented for chiropractic care. Her sleep was limited to 2 consecutive hours due to bladder urgency. Pubic symphysis shear dysfunction was observed on physical examination. Intervention and outcomes: The primary treatment modality used was chiropractic side-posture drop-table manipulation designed to reduce pubic shear dysfunction. After 8 treatments in 1 month, the pubic shear gradually reduced while nocturia diminished and consecutive sleep hours increased from 2 to 7. At 1-year follow-up, the nocturia remained resolved. Conclusion: The patient reported in this case responded favorably to chiropractic care, which resulted in reduced nocturia and increased sleep continuity.

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Anatomy of pudendal nerve at urogenital diaphragm—new critical site for nerve entrapment

Cited by 60 publications

References 22 publications

Surgical treatment of nervus pudendus

Surgical treatment of nervus pudendus

Sensory recovery after decompression of the distal pudendal nerve: Anatomical review and quantitative neurosensory data of a prospective clinical study

Chiropractic Management of Pubic Symphysis Shear Dysfunction in a Patient With Overactive Bladder

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