Abstract
Background
Injury to the pudendal nerve leads to bowel/bladder incontinence which compromises the quality of life in these patients. Many peripheral nerves have been used to neurotize the pudendal nerve in order to regain bladder continence. The aim of this study was to assess the anatomic feasibility, by ultrasound, of transfer of the femoral nerve’s motor branch to the vastus lateralis (MNVL) to the pudendal nerve for restoring continence.
Methods
Thirty healthy male volunteers were randomly selected, irrespective of age. The origin of MNVL was traced in the distal thigh, to the level the nerve was visible using high-frequency ultrasound probe. The length of the nerve was measured with the help of a measuring tape. The pudendal nerve was identified just medial to the ischial tuberosity on the same side. The distance between the origin of MNVL and the pudendal nerve was measured. The same procedure was performed in the opposite side.
Results
MNVL has enough length and calibre to neurotize the pudendal nerve in 28/30 (93.33%) individuals on the right side, and in 29/30 (96.66%) individuals on the left side.
Conclusions
On ultrasonography, length of MNVL was found sufficient to reach the pudendal nerve in majority of the patients. USG can be a tool to assess the feasibility of transfer of MNVL to the pudendal nerve.
Level of evidence: Level IV, risk/prognostic study.
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References
Wilson L, Brown JS, Shin GP, Luc KO, Subak LL (2001) Annual direct cost of urinary incontinence. Obstet Gynecol 98:398–406
Barbe MF, Brown JM, Pontari MA, Dean GE, Braverman AS, Ruggieri MR (2011) Feasibility of a femoral nerve motor branch for transfer to the pudendal nerve for restoring continence: a cadaveric study. J Neurosurg Spine 15:526–531
Agarwal P, Mishra AN, Wankhede S, Mukati P, Sharma D (2019) Priorities of functions following spinal cord injury (SCI). JCOT in press. https://doi.org/10.1016/j.jcot.2019.08.001
Kao JT, Burton D, Comstock C, McClellan RT, Carragee E (1993) Pudendal nerve palsy after femoral intramedullary nailing. J Orthop Trauma 7:58–63
Shetty SD, Kirkemo AK (1997) Bilateral bone anchor vaginal vault suspension: an initial report of a new technique. Tech Urol 3:1–5
Gillitzer R, Hampel C, Wiesner C, Pahernik S, Melchior SW, Thüroff JW (2006) Pudendal nerve branch injury during radical perineal prostatectomy. Urology 67:423.e1–423.e3
Gomez-Amaya SM, Barbe MF, de Groat WC, Brown JM, Tuite GF, Corcos J, Fecho SB, Braverman AS, Ruggieri MR Sr (2015) Neural reconstruction methods of restoring bladder function. Nat Rev Urol 12:100–118
Ruggieri MR, Brown JM, Braverman AS, Bernal RM, Pontari MA, Dean GE et al (2012) Transfer of femoral nerve branches to pudendal nerve branches reinnervate the urethral and anal sphincters in a canine model and is feasible in a cadaver study. J Urol 187:e42
Agarwal P, Sharma D, Dr Wankhede S, Jain PC, Agrawal NL (2019) Sciatic nerve to pudendal nerve transfer: anatomical feasibility for a new proposed technique. Indian J Plast Surg 52:222–225
Brown JM, Barbe MF, Albo ME, Lai HH, Ruggieri MR Sr (2012) Anatomical feasibility of performing intercostal and ilioinguinal nerve to pelvic nerve transfer: a possible technique to restore lower urinary tract innervation. J Neurosurg Spine 17:357–362
Agarwal P, Parihar V, Kukrele RR, Kumar A, Sharma D. (2019)Feasibility of intercostal nerves anastomosis to S2 root and lumbar plexus for management of spinal cord injury: a cadaveric study. J Clin Orthop Trauma, in press
Winkelmann A (2007) Anatomical dissection as a teaching method in medical school: a review of the evidence. Med Educ 41:15–22
Vaccarezza M, Papa V (2013) Teaching anatomy in the XXI century: new aspects and pitfalls. Sci World J 2013:310348
Peer S, Kovacs P, Harpf C, Bodner G (2002) High-resolution sonography of lower extremity peripheral nerves: anatomic correlation and spectrum of disease. J Ultrasound Med 21:315–322
Suk JI, Walker FO, Cartwright MS (2013) Ultrasonography of peripheral nerves. Curr Neurol Neurosci Rep 13:328
Revenaugh PC, Knott D, McBride JM, Fritz MA (2012) Motor nerve to the vastus lateralis. Arch Facial Plast Surg 14:365–368
Gustafson KJ, Pinault GC, Neville JJ, Syed I, Davis JA Jr, Jean-Claude J et al (2009) Fascicular anatomy of human femoral nerve: implications for neural prostheses using nerve cuff electrodes. J Rehabil Res Dev 46:973–984
Kapoor R, Adhikary SD, Siefring C, McQuillan PM (2012) The saphenous nerve and its relationship to the nerve to the vastus medialis in and around the adductor canal: an anatomical study. Acta Anaesthesiol Scand 56:365–367
Hanasono MM, Skoracki RJ, Yu P (2010) A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg 125:209–214
Humphrey CD, Kriet JD (2008) Nerve repair and cable grafting for facial paralysis. Facial Plast Surg 24:170–176
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Pawan Agarwal, Geetesh Ratre, Sanjoy Pandey and D. Sharma declare that they have no conflict of interest.
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Agarwal, P., Ratre, G., Pandey, S. et al. Assessment of feasibility of neuronal reinnervation of pudendal nerve by femoral nerve’s motor branch to vastus lateralis: an ultrasound-guided study. Eur J Plast Surg 43, 779–784 (2020). https://doi.org/10.1007/s00238-020-01675-3
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DOI: https://doi.org/10.1007/s00238-020-01675-3