Benjamin Alcock and the Pudendal Canal

Colebunders, Britt; Matthew, Michael K.; Broerm, Niclas; Persing, John A.; Dellon, A. Lee

doi:10.1055/s-0031-1278705

Cited by 24 publications

(20 citation statements)

References 10 publications

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“…In consent with Colebunders and co‐workers and by definition, ‘ Alcock's Canal’ does not include the PN within the pelvis, the region between the sacrospinous ligament and sacrotuberous ligament, the region in which the rectal branch of the PN crosses the curved falciform process connecting the sacrotuberous ligament to the ischial tuberosity at the site of the obturator foramen and, finally, the passage of the PN along the ramus of the pubis towards the pubic symphysis …”

Section: Discussionmentioning

confidence: 99%

New laparoscopic approach to the pudendal nerve for neuromodulation based on an anatomic study

Konschake

Brenner

Moriggl

et al. 2016

Neurourology and Urodynamics

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AIMS:The aim was to develop a new laparoscopic technique for placement of a pudendal lead. METHODS: Development of a direct, feasible and reliable minimal-invasive laparoscopic approach to the pudendal nerve (PN). Thirty-one embalmed human specimens were dissected for the relevant anatomic structures of the pelvis.Stepby-step documentation and analysis of the laparoscopic approach in order to locate the PN directly in its course around the medial part of the sacrospinous ligament and test this approach for feasibility. Landmarks for intraoperative navigation towards the PN as well as the possible position of an lead were selected and demonstrated. RESULTS: The visible medial umbilical fold, the intrapelvine part of the internal pudendal artery, the coccygeus muscle and the sacrospinous ligament are the main landmarks. The PN traverses the medial part of the sacrospinous ligament dorsally, medially to the internal pudendal artery. The medial part of the sacrospinous ligament has to be exposed in order to display the nerve. An lead can be placed ventrally on the nerve or around it, depending on the lead type or shape. CONCLUSIONS: A precise and reliable identification of the PN by means of laparoscopy is feasible with an easy four-step approach: (1) identification of the medial umbilical fold; (2) identification of the internal iliac artery; (3) identification of the internal pudendal artery and incision of the coccygeus muscle ('white line', arcuated line); and (4) exposition of the medial part of the sacrospinous ligament to display the PN. K E Y W O R D Sinternal pudendal artery, laparoscopic approach, medial umbilical fold, neuromodulation, pudendal nerve, sacrospinous ligament

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Section: Discussionmentioning

confidence: 99%

New laparoscopic approach to the pudendal nerve for neuromodulation based on an anatomic study

Konschake

Brenner

Moriggl

et al. 2016

Neurourology and Urodynamics

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“…The incision was opened into the ischiorectal fossa and maintained open with a Weitlander retractor with blunt “teeth.” Dissecting posteriorly and inferiorly, the perineal branches were identified, and preserved. In 10 % of patients the dorsal branch will exit through the canal of Alcock (Colebunders, Matthew, Broer, Persing, & Dellon, ), and so this variant must be identified. If it is present, then the scarring around the exit must be released, and this would complete the procedure.…”

Section: Methodsmentioning

confidence: 99%

Persistent genital arousal disorder: Treatment by neurolysis of dorsal branch of pudendal nerve

Klifto

Dellon

2019

Microsurgery

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Background Persistent genital arousal disorder (PGAD) is a woman's perception that she is in a state of sexual arousal, without the ability of arousal to be satisfied by orgasm. It is the hypothesis of this study that PGAD results from a minimal degree of nerve compression of the dorsal branch of the pudendal nerve. If this is true, PGAD could be treated by neurolysis of the dorsal branch of the pudendal nerve. Methods A retrospective chart review from 2010 through 2018, of those women having neurolysis of the dorsal branch of the pudendal nerve for PGAD. The main outcome measures were the pre‐operative and post‐operative changes in clitoral symptoms (arousal, numbness, pain). Results Eight women included in this study were followed more than 26 weeks since surgery (mean = 65, range = 26–144 weeks). Seven of these women had the surgery bilaterally, and each of these had an excellent result, meaning elimination of the arousal symptoms, and the ability to resume normal sexual intercourse. The patient with unilateral decompression of the dorsal branch of the pudendal nerve was the only patient who had some, versus complete improvement in arousal symptoms. Of the seven women that had pain, six had complete relief and one had partial relief. No major surgical complications were observed. Conclusion The relief of arousal symptoms by neurolysis of the dorsal nerve to the clitoris supports the hypothesis that PGAD is due to a minimal degree of compression of the dorsal branch of the pudendal nerve.

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“…Distal to the sacrotuberous and sacrospinous ligaments, the pudendal nerve reenters the pelvis through the lesser sciatic foramen and enters Alcock's canal [ 21 ]. This canal lies medial to the obturator internus muscle and is formed by a splitting of the muscle's fascia into a medial and lateral layer.…”

Section: Alcock's Canalmentioning

confidence: 99%