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Published in: Surgical and Radiologic Anatomy 10/2009

01-12-2009 | Original Article

Surgical anatomy of the extrapelvic part of the pudendal nerve and its applications for clinical practice

Authors: Nicolas Pirro, Igor Sielezneff, Thomas Le Corroller, Mehdi Ouaissi, Bernard Sastre, Pierre Champsaur

Published in: Surgical and Radiologic Anatomy | Issue 10/2009

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Abstract

Purpose

This study aims to report the topography of the extrapelvic part of the pudendal nerve (EPPN) and its relationship with the sacrospinous ligament and the pudendal artery.

Methods

The pudendal nerve (PN) was dissected by a gluteal approach in 40 cases. The morphology of the EPPN, its topography and the relationship between the PN on the one hand, and the pudendal artery and the tip of the ischial spine on the other hand were reported.

Results

The length and the diameter of the EPPN were identical on the right and on the left side. The PN was a single trunk in 3/4 of cases. The PN was medial to the pudendal artery in 32 cases and crossed the sacrospinous ligament in 32 cases and the ischial spine in 6 cases.

Conclusions

The topographic variations of the EPPN are large and complicate its surgical and radiological approach.
Literature
1.
go back to reference Alevizon SJ, Finan MA (1996) Sacrospinous colpopexy: management of postoperative PN entrapment. Obstet Gynecol 88:713–715CrossRefPubMed Alevizon SJ, Finan MA (1996) Sacrospinous colpopexy: management of postoperative PN entrapment. Obstet Gynecol 88:713–715CrossRefPubMed
2.
go back to reference Becker CM, Gueuning CO, Graff GL (1985) Sutures of fibrin glue for divided rat nerves: Schwann cell and muscle metabolism. Microsurgery 6:1–10CrossRefPubMed Becker CM, Gueuning CO, Graff GL (1985) Sutures of fibrin glue for divided rat nerves: Schwann cell and muscle metabolism. Microsurgery 6:1–10CrossRefPubMed
3.
go back to reference Groen J, Amiel C, Bosch JL (2005) Chronic pudendal nerve neuromodulation in women with idiopathic refractory detrusor overactivity incontinence: results of a pilot study with a novel minimally invasive implantable mini-stimulator. Neurourol Urodyn 24:226–230CrossRefPubMed Groen J, Amiel C, Bosch JL (2005) Chronic pudendal nerve neuromodulation in women with idiopathic refractory detrusor overactivity incontinence: results of a pilot study with a novel minimally invasive implantable mini-stimulator. Neurourol Urodyn 24:226–230CrossRefPubMed
4.
go back to reference Gruber H, Kovacs P, Piegger J, Brenner E (2001) New, simple, ultrasound-guided infiltration of the pudendal nerve: topographic basics. Dis Colon Rectum 44:1376–1380CrossRefPubMed Gruber H, Kovacs P, Piegger J, Brenner E (2001) New, simple, ultrasound-guided infiltration of the pudendal nerve: topographic basics. Dis Colon Rectum 44:1376–1380CrossRefPubMed
5.
go back to reference Gustafson KJ, Zelkovic PF, Feng AH, Draper CE, Bodner DR, Grill WM (2005) Fascicular anatomy and surgical access of the human pudendal nerve. World J Urol 23:411–418CrossRefPubMed Gustafson KJ, Zelkovic PF, Feng AH, Draper CE, Bodner DR, Grill WM (2005) Fascicular anatomy and surgical access of the human pudendal nerve. World J Urol 23:411–418CrossRefPubMed
6.
go back to reference Juenemann KP, Lue TF, Schmidt RA, Tanagho EA (1988) Clinical significance of sacral and pudendal nerve anatomy. J Urol 139:74–80PubMed Juenemann KP, Lue TF, Schmidt RA, Tanagho EA (1988) Clinical significance of sacral and pudendal nerve anatomy. J Urol 139:74–80PubMed
7.
go back to reference Kovacs P, Gruber H, Piegger J, Bodner G (2001) New, simple, ultrasound-guided infiltration of the pudendal nerve: ultrasonographic technique. Dis Colon Rectum 44:1381–1385CrossRefPubMed Kovacs P, Gruber H, Piegger J, Bodner G (2001) New, simple, ultrasound-guided infiltration of the pudendal nerve: ultrasonographic technique. Dis Colon Rectum 44:1381–1385CrossRefPubMed
8.
go back to reference Leroi AM, Parc Y, Lehur PA, Mion F, Barth X, Rullier E et al (2005) Efficacy of sacral nerve stimulation for fecal incontinence: results of a multicenter double-blind crossover study. Ann Surg 242:662–669CrossRefPubMed Leroi AM, Parc Y, Lehur PA, Mion F, Barth X, Rullier E et al (2005) Efficacy of sacral nerve stimulation for fecal incontinence: results of a multicenter double-blind crossover study. Ann Surg 242:662–669CrossRefPubMed
9.
go back to reference Mahakkanukrauh P, Surin P, Vaidhayakarn P (2005) Anatomical study of the pudendal nerve adjacent to the sacrospinous ligament. Clin Anat 18:200–205CrossRefPubMed Mahakkanukrauh P, Surin P, Vaidhayakarn P (2005) Anatomical study of the pudendal nerve adjacent to the sacrospinous ligament. Clin Anat 18:200–205CrossRefPubMed
10.
go back to reference Mauillon J, Thoumas D, Leroi AM, Freger P, Michot F, Denis P (1999) Results of pudendal nerve neurolysis-transposition in twelve patients suffering from pudendal neuralgia. Dis Colon Rectum 42:186–192CrossRefPubMed Mauillon J, Thoumas D, Leroi AM, Freger P, Michot F, Denis P (1999) Results of pudendal nerve neurolysis-transposition in twelve patients suffering from pudendal neuralgia. Dis Colon Rectum 42:186–192CrossRefPubMed
11.
go back to reference Palazzi S, Vila-Torres J, Lorenzo JC (1995) Fibrin glue is a sealant and not a nerve barrier. J Reconstruct Microsurg 11:135–139CrossRef Palazzi S, Vila-Torres J, Lorenzo JC (1995) Fibrin glue is a sealant and not a nerve barrier. J Reconstruct Microsurg 11:135–139CrossRef
12.
go back to reference Pirro N, Konate I, Sielezneff I, Di Marino V, Sastre B (2005) Anatomic bases of graciloplasty using end-to-side nerve pudendal anastomosis. Surg Radiol Anat 27:409–413CrossRefPubMed Pirro N, Konate I, Sielezneff I, Di Marino V, Sastre B (2005) Anatomic bases of graciloplasty using end-to-side nerve pudendal anastomosis. Surg Radiol Anat 27:409–413CrossRefPubMed
13.
go back to reference Pirro N, Sielezneff I, Malouf A, Ouaissi M, Di Marino V, Sastre B (2005) Anal sphincter reconstruction using a transposed gracilis muscle with a pudendal nerve anastomosis: a preliminary anatomic study. Dis Colon Rectum 48:2085–2089CrossRefPubMed Pirro N, Sielezneff I, Malouf A, Ouaissi M, Di Marino V, Sastre B (2005) Anal sphincter reconstruction using a transposed gracilis muscle with a pudendal nerve anastomosis: a preliminary anatomic study. Dis Colon Rectum 48:2085–2089CrossRefPubMed
14.
go back to reference O’Bichere A, Green C, Phillips RK (2000) New, simple approach for maximal pudendal nerve exposure: anomalies and prospects for functional reconstruction. Dis Colon Rectum 43:956–960CrossRefPubMed O’Bichere A, Green C, Phillips RK (2000) New, simple approach for maximal pudendal nerve exposure: anomalies and prospects for functional reconstruction. Dis Colon Rectum 43:956–960CrossRefPubMed
15.
go back to reference Olszewski J (1982) Variations of the pudendal nerve in man. Folia Morphol (Warsz) 41:245–252 Olszewski J (1982) Variations of the pudendal nerve in man. Folia Morphol (Warsz) 41:245–252
16.
go back to reference Robert R, Prat-Pradal D, Labat JJ, Bensignor M, Raoul S, Rebai R et al (1998) Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surg Radiol Anat 20:93–98CrossRefPubMed Robert R, Prat-Pradal D, Labat JJ, Bensignor M, Raoul S, Rebai R et al (1998) Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surg Radiol Anat 20:93–98CrossRefPubMed
17.
go back to reference Robert R, Labat JJ, Bensignor M, Glemain P, Deschamps C, Raoul S et al (2005) Decompression and transposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation. Eur Urol 47:403–408CrossRefPubMed Robert R, Labat JJ, Bensignor M, Glemain P, Deschamps C, Raoul S et al (2005) Decompression and transposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation. Eur Urol 47:403–408CrossRefPubMed
18.
go back to reference Roberts WH, Taylor WH (1973) Inferior rectal nerve variations as it relates to pudendal block. Anat Rec 177:461–463CrossRefPubMed Roberts WH, Taylor WH (1973) Inferior rectal nerve variations as it relates to pudendal block. Anat Rec 177:461–463CrossRefPubMed
19.
go back to reference Sames M, Blahos J, Rokyta R, Benes V (1997) Comparison of microsurgical suture with fibrin glue connection of the sciatic nerve in rabbits. Physiol Res 46:303–306PubMed Sames M, Blahos J, Rokyta R, Benes V (1997) Comparison of microsurgical suture with fibrin glue connection of the sciatic nerve in rabbits. Physiol Res 46:303–306PubMed
20.
go back to reference Sato T, Nagai H (2002) Sacral magnetic stimulation for pain relief from pudendal neuralgia and sciatica. Dis Colon Rectum 45:280–282CrossRefPubMed Sato T, Nagai H (2002) Sacral magnetic stimulation for pain relief from pudendal neuralgia and sciatica. Dis Colon Rectum 45:280–282CrossRefPubMed
21.
go back to reference Sato T, Konishi F, Kanazawa K (1997) Anal sphincter reconstruction with a pudendal nerve anastomosis following abdominoperineal resection: report of a case. Dis Colon Rectum 40:1497–1502CrossRefPubMed Sato T, Konishi F, Kanazawa K (1997) Anal sphincter reconstruction with a pudendal nerve anastomosis following abdominoperineal resection: report of a case. Dis Colon Rectum 40:1497–1502CrossRefPubMed
22.
go back to reference Sato T, Konishi F, Kanazawa K (1997) Functional perineal colostomy with pudendal nerve anastomosis following anorectal resection: a cadaver operation study on a new procedure. Surgery 121:569–574CrossRefPubMed Sato T, Konishi F, Kanazawa K (1997) Functional perineal colostomy with pudendal nerve anastomosis following anorectal resection: a cadaver operation study on a new procedure. Surgery 121:569–574CrossRefPubMed
23.
go back to reference Schraffordt SE, Tjandra JJ, Eizenberg N, Dwyer PL (2004) Anatomy of the pudendal nerve and its terminal branches: a cadaver study. ANZ J Surg 74:23–26CrossRefPubMed Schraffordt SE, Tjandra JJ, Eizenberg N, Dwyer PL (2004) Anatomy of the pudendal nerve and its terminal branches: a cadaver study. ANZ J Surg 74:23–26CrossRefPubMed
24.
go back to reference Shafik A, el-Sherif M, Youssef A, Olfat ES (1995) Surgical anatomy of the pudendal nerve and its clinical implications. Clin Anat 8:110–115CrossRefPubMed Shafik A, el-Sherif M, Youssef A, Olfat ES (1995) Surgical anatomy of the pudendal nerve and its clinical implications. Clin Anat 8:110–115CrossRefPubMed
25.
go back to reference Sikorski A, Olszewski J, Miekos E (1987) Anatomical considerations of selective pudendal neurectomy. Int Urol Nephrol 19:159–163CrossRefPubMed Sikorski A, Olszewski J, Miekos E (1987) Anatomical considerations of selective pudendal neurectomy. Int Urol Nephrol 19:159–163CrossRefPubMed
26.
go back to reference Spinelli M, Malaguti S, Giardiello G, Lazzeri M, Tarantola J, Van Den Hombergh U (2005) A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder: description of the method and preliminary data. Neurourol Urodyn 24:305–309CrossRefPubMed Spinelli M, Malaguti S, Giardiello G, Lazzeri M, Tarantola J, Van Den Hombergh U (2005) A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder: description of the method and preliminary data. Neurourol Urodyn 24:305–309CrossRefPubMed
27.
go back to reference Thoumas D, Leroi AM, Mauillon J, Muller JM, Benozio M, Denis P et al (1999) Pudendal neuralgia: CT-guided pudendal nerve block technique. Abdom Imaging 24:309–312CrossRefPubMed Thoumas D, Leroi AM, Mauillon J, Muller JM, Benozio M, Denis P et al (1999) Pudendal neuralgia: CT-guided pudendal nerve block technique. Abdom Imaging 24:309–312CrossRefPubMed
28.
go back to reference Uludag O, Morren GL, Dejong CH, Baeten CG (2005) Effect of sacral neuromodulation on the rectum. Br J Surg 92:1017–1023CrossRefPubMed Uludag O, Morren GL, Dejong CH, Baeten CG (2005) Effect of sacral neuromodulation on the rectum. Br J Surg 92:1017–1023CrossRefPubMed
Metadata
Title
Surgical anatomy of the extrapelvic part of the pudendal nerve and its applications for clinical practice
Authors
Nicolas Pirro
Igor Sielezneff
Thomas Le Corroller
Mehdi Ouaissi
Bernard Sastre
Pierre Champsaur
Publication date
01-12-2009
Publisher
Springer-Verlag
Published in
Surgical and Radiologic Anatomy / Issue 10/2009
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI
https://doi.org/10.1007/s00276-009-0518-7

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