Topography and landmarks for the nerve supply to the levator ani and its relevance to pelvic floor pathologies

Loukas, Marios; Joseph, Shamfa C.; Etienne, Denzil; Linganna, Sanjay; Hallner, Barry; Tubbs, R. Shane

doi:10.1002/ca.22668

Cited by 9 publications

(7 citation statements)

References 31 publications

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“…However, most studies have focused on the piriformis muscle in regard to such syndromes (Fishman et al, ; Filler et al, ). Regional nerves such as the sciatic, superior and inferior gluteal nerves, nerve to the obturator internus, and pudendal nerve have been less focused on in regard to this syndrome (Filler, ; Loukas et al, ).…”

Section: Introductionmentioning

confidence: 99%

The majority of piriformis muscles are innervated by the superior gluteal nerve

et al. 2018

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The piriformis muscle is clinically implicated in pain disorders, posterior approaches for total hip arthroplasty, and iatrogenic injury to the muscle and the surrounding nerves. The piriformis muscle has been said to receive innervation from L5 to S3 ventral rami with most sources using S1 and S2 ventral rami as the most common innervation this muscle. However, descriptions of the nerve in the literature are vague. Therefore, the aim of this study was to clarify the anatomy of the nerve supply to the piriformis muscle. Twenty sides from ten fresh-frozen cadavers were studied. Specifically, via anterior dissection of the sacral plexus, branches to the piriformis were identified. Once identified, the nerves to the piriformis muscle were traced proximally to clarify their origin. Nerves supplying the piriformis muscle existed on all sides. On 80% of sides, the piriformis was innervated by two to three nerves. The origin of these nerves was from the superior gluteal nerve on 14 sides (70%), inferior gluteal nerve on one side (5%), L5 ventral ramus on one side (5%), S1 ventral ramus on 17 sides (85%), and S2 ventral ramus on 14 sides (70%), respectively. The most common nerve branches to the piriformis are from the superior gluteal nerve, and the ventral rami of S1 and S2. Based on our study, a single "nerve to piriformis" does not exist in the majority of specimens thus this term should be abandoned.

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Section: Introductionmentioning

confidence: 99%

The majority of piriformis muscles are innervated by the superior gluteal nerve

et al. 2018

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“…In addition, variability of the pelvic and perineal innervation of the peri-urethral musculature in most animal models including the rabbit are poorly described. In humans the levator ani which innervates the pelvic floor muscles has five different branching patterns ( Rousset et al, 2012 ; Loukas et al, 2016 ; Plochocki et al, 2016 ). Also, the P ura values in this study represent a single point measurement, while in women these are estimated with a profilometry along the urethral canal ( Stafford et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Secondary urethral sphincter function of the rabbit pelvic and perineal muscles

Hernández-Reynoso

Rahman²,

Hedden³

et al. 2023

Front. Neurosci.

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Perineal and pelvic floor muscles play an important role in continence by providing mechanical support to pelvic organs. It is also known that the pubococcygeus muscle (PcM) contracts in the storage phase and is inactive during voiding, while the bulbospongiosus muscle (BsM) is active during the voiding phase. Recent evidence suggested an additional role of these muscles in supporting urethral closure in rabbits. However, the individual role of perineal and pelvic muscles as urethral sphincters is not well-defined. Here we evaluated the individual, sequential and synergistic roles of the PcM and BsM in assisting urethral closure and defined the optimal electrical stimulation parameters that can effectively contract these muscles and increase the urethral pressure (Pura) in young nulliparous animals (n = 11). Unilateral stimulation of either the BsM or PcM at 40 Hz induced modest increases in average Pura (0.23 ± 0.10 and 0.07 ± 0.04 mmHg, respectively). Investigation on the changes in Pura evoked by stimulation frequencies between 5 and 60 Hz show that sequential contralateral PcM-BsM activation at 40 Hz induced a 2-fold average Pura increase (0.23 ± 0.07 mmHg) compared to that evoked by PcM stimulation. Simultaneous activation of PcM and BsM at 40 Hz also showed an increased average Pura (0.26 ± 0.04 mmHg), with a 2-fold increase in average Pura observed during the unilateral sequential PcM-BsM stimulation at 40 Hz (0.69 ± 0.2 mmHg). Finally, stimulation at 40 Hz of the bulbospongiosus nerve (BsN) induced an approximate 4-fold increase in average Pura (0.87 ± 0.44 mmHg; p < 0.04) compared to that elicited by BsM stimulation, confirming that direct nerve stimulation is more effective. Together, this study shows that in the female rabbit, both perineal and pelvic muscles support of the urethral function during continence, and that unilateral stimulation of the BsN at 40–60 Hz is sufficient to achieve maximal secondary sphincter activity. The results also support the potential clinical value of neuromodulation of pelvic and perineal nerves as bioelectronic therapy for stress urinary incontinence.

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“…provides small direct motor branches to the levator ani. The innervation of the levator ani has since been studied in 100 cadavers [23]. By convention, the electrodes on the quadripolar lead are numbered between 0 and 3 starting with the most distal electrode (Figure 2A).…”

Section: Electrodementioning

confidence: 99%

“…provides small direct motor branches to the levator ani. The innervation of the levator ani has since been studied in 100 cadavers [23].…”

Section: Charge Field Characteristicsmentioning

confidence: 99%

“…Physiological data obtained in five patients with bladder conditions during early evaluation of SNM [22] suggest that, in addition to textbook contributions to the pudendal nerve and sciatic nerve, S3 provides small direct motor branches to the levator ani. The innervation of the levator ani has since been studied in 100 cadavers [23]. Fifteen subjects had direct contributions from S3 with the remainder having direct contributions from S4 and/or S5 branches.…”

Section: Applied Anatomymentioning

confidence: 99%

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The science behind programming algorithms for sacral neuromodulation

et al. 2020

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On the basis of sustained long-term results, sacral neuromodulation (SNM) has become a widely adopted and established treatment modality for overactive bladder, non-obstructive urinary retention and faecal incontinence [1-6]. Since its approval for clinical use in 1994 more than 325 000 patients have been treated worldwide with several further potential indications under investigation [7]. In the majority (about 80%) of patients undergoing implantation, SNM leads to a clinically significant reduction in symptoms [1,8-10]. However, it is recognized that, even within this group, a

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Topography and landmarks for the nerve supply to the levator ani and its relevance to pelvic floor pathologies

Cited by 9 publications

References 31 publications

The majority of piriformis muscles are innervated by the superior gluteal nerve

The majority of piriformis muscles are innervated by the superior gluteal nerve

Secondary urethral sphincter function of the rabbit pelvic and perineal muscles

The science behind programming algorithms for sacral neuromodulation

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