Intraligamentous nerves as a potential source of pain after sacrospinous ligament fixation of the vaginal apex

Barksdale, Phillip A.; Gasser, Raymond F.; Gauthier, C. M.; Elkins, Thomas E.; Wall, L. Lewis

doi:10.1007/bf02764841

Cited by 38 publications

(21 citation statements)

References 12 publications

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“…Entrapment of the PN may result in loss of motor and/or sensory function as well as chronic pain syndromes [11,25], whereas entrapment of the IRN may lead to fecal incontinence [23]. …”

Section: Discussionmentioning

confidence: 99%

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The Pudendal Nerve and Its Branches in Relation to Richter's Procedure

Walt

Oettlé

Wijk³

2015

Gynecol Obstet Invest

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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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“…Entrapment of the PN may result in loss of motor and/or sensory function as well as chronic pain syndromes [11,25], whereas entrapment of the IRN may lead to fecal incontinence [23]. …”

Section: Discussionmentioning

confidence: 99%

“…In the gluteal region, the PN descends posterior to the sacrospinous ligament and may be entrapped by a placed Richter's stitch [19]. Entrapment of the PN may result in loss of motor and/or sensory function as well as chronic pain syndromes [11,25]. Buttock pain is a common postoperative symptom after sacrospinous colpopexy.…”

Section: Introductionmentioning

confidence: 99%

The Pudendal Nerve and Its Branches in Relation to Richter's Procedure

Walt

Oettlé

Wijk³

2015

Gynecol Obstet Invest

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“…Entrapment of the pudendal nerve or branches during perineal surgery could result in sexual dysfunction. [1][2][3][4] Findings in the literature researched are inconsistent and do not provide detailed descriptions of the anatomy of the PN in its entirety, including possible variations that could be encountered during procedures. [5][6][7][8][9][10][11] Some of the discrepancies reported could be attributed to limited sample sizes, limited exposure or differences in terminologies or populations used.…”

Section: Introductionmentioning

confidence: 99%

“…During the Richter's procedure, the pudendal nerve (PN), sciatic nerve and inferior gluteal vessels are at risk as the anterior or posterior vaginal wall is suspended to the sacrospinous ligament. 1,2,5,[16][17][18][19][20] During this procedure a stitch is placed through the anterior or posterior vaginal wall and into the sacrospinous ligament. PN and dorsal penile nerve block; ischioanal abscess and fistula drainage and several urinary incontinence mesh tapes procedures in which a mesh is placed under the mid-urethra for the treatment of stress urinary incontinence in males and females.…”

Section: Introductionmentioning

confidence: 99%

Surgical anatomy of the pudendal nerve and its branches in South Africans

2015

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ABSTRACT:Dissection of the pudendal nerve and its branches in 71 cadavers revealed anatomic variations not previously described. Knowledge of this variation is necessary to prevent nerve injury resulting in sexual of sensory dysfunction. Because descriptions vary, this study re-evaluated the anatomy of the PN as implicated in perineal procedures in South Africans. The course of the PN from the gluteal region into the perineum was dissected in an adult sample of both sexes and of African and Predictions should be verified clinically.

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“…Intra-and postoperative complications include hemorrhage with a 2% transfusion risk, injury to the pudendal nerve, and injury to neighboring organs [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Sexual function after sacrospinous fixation for vaginal vault prolapse: Bad or Mad?

Uzeda¹,

Baumann²,

Salvisberg³

et al. 2008

Geburtsh Frauenheilk

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Background The main indication for sacrospinous ligament suspension is to correct either total procidentia, a posthysterectomy vaginal vault prolapse with an associated weak cardinal uterosacral ligament complex, or a posthysterectomy enterocele. This study aimed to evaluate sexual function and anatomic outcome for patients after sacrospinous ligament suspension. Methods For this study, 52 patients who had undergone sacrospinous ligament fixation during the preceding 5 years were asked to complete the Female Sexual Function Index (FSFI) questionnaire. The patients were vaginally examined using the ICS POP score, and the results were compared with their preoperative status. For statistical analysis, GraphPad for Windows, version 4.0, was used. Results The 52 patients were examined during a followup period of 38 months. No major intraoperative complications were noted. Recurrence of symptomatic apical descent was noted in 6% of the patients and de novo prolapse in 13.5%. Only one patient was symptomatic. Three patients experienced de novo dyspareunia, which resolved in two cases after stitch removal. Sexual function was good, rating higher than three points for each of the domains including satisfaction, lubrication, desire, orgasm, and pain. Conclusion Sacrospinous ligament fixation still is a valuable option for the treatment of vaginal vault prolapse.Sexual function is satisfactory, with few cases of de novo dyspareunia.

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Intraligamentous nerves as a potential source of pain after sacrospinous ligament fixation of the vaginal apex

Cited by 38 publications

References 12 publications

The Pudendal Nerve and Its Branches in Relation to Richter's Procedure

The Pudendal Nerve and Its Branches in Relation to Richter's Procedure

Surgical anatomy of the pudendal nerve and its branches in South Africans

Sexual function after sacrospinous fixation for vaginal vault prolapse: Bad or Mad?

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