Article
Pudendal nerve entrapment – surgical anatomy, diagnosis and therapy
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Published: | September 3, 2014 |
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Objective: Pudendal nerve entrapment (PNE) is anuncommon entity, with a heterogenous clinical picture. Thus, adequate diagnosis is difficult and PNE is frequently overlooked or misdiagnosed. The nerve´s anatomy is complex and difficult to approach. In this report we present the different clinical pictures of PNE and elucidate the underlying anatomical features and relationships to certain landmarks for optimal orientation and interventional/surgical access.
Methods: We dissected 15 fresh frozen pelves (24 hemipelves and 3 intact pelves) under 3.5x loupe magnification. Anatomical details and relations of the pudendal nerve along its course from the sacral plexus to the dorsum of the clitoris/penis were documented in charts, illustrative graphs and photos. Potential entrapment sites and the best correspondent surgical approach were recorded. Finally, we describe selected clinical cases to highlight the clinical relevance of this report and complete the anatomical data.
Results: The pudendal nerve and its branches are susceptible to compression at several sites along their course: the sacral region, infrapiriform notch, the sciatic spine, the lesser sciatic foramen, the pudendal canal (Alcock), the urogenital diaphragm and the anterior pubic canal, i.e. a tight osteofibrotic canal just distal to the urogenital diaphragm. The clinical picture depends on the height of entrapment. Adequate diagnosis, anatomical details, landmarks, aid for nerve identification, and the best surgical access to respective entrapment sites are presented.
Conclusions: Pudendal nerve entrapment is a rare neuropathy that greatly impairs patients’ quality of life. The pudendal nerve is susceptible to compression at different sites along its passage. Knowledge of the clinical and anatomical details presented here facilitates adequate diagnosis and therapy, i.e. directed surgical decompression – an easy and straightforward operation for the relief of patients´ symptoms.