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Anatomy of the pudendal nerve in clinically important areas: a pictorial essay and narrative review

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Abstract

Purpose

The pudendal nerve is an anatomical structure arising from the ventral branches of the spinal roots S2–S4. Its complex course may be affected by surrounding structures. This may result in irritation or entrapment of the nerve with subsequent clinical symptoms. Aim of this study is to review the anatomy of the pudendal nerve and to provide detailed photographic documentation of the areas with most frequent clinical impact which are essential for surgical approach.

Methods

Major medical databases were searched to identify all anatomical studies investigating pudendal nerve and its variability, and possible clinical outcome of these variants. Extracted data consisted of morphometric parameters, arrangement of the pudendal nerve at the level of roots, formation of pudendal nerve, position according to sacrospinal and sacrotuberal ligaments and its terminal branches. One female cadaver hemipelvis was dissected with common variability of separate course of inferior rectal nerve. During dissection photodocumentation was made to record course of pudendal nerve with focus on areas with recorded pathologies and areas exposed to iatrogenic damage during surgical procedures.

Results

Narrative review was done to provide background for photodocumentation. Unique photos of course of the pudendal nerve was made in areas with great clinical significance.

Conclusion

Knowledge of anatomical variations and course of the pudendal nerve is important for examinations and surgical interventions. Surgically exposed areas may become a site for iatrogenic damage of pudendal nerve; therefore, unique picture was made to clarify topographic relations.

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Data availability

Please contact authors for data requests (honza.zaple@seznam.cz).

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Acknowledgements

The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind’s overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude.

Funding

The work was supported by Cooperatio project Maternal and Childhood Care (No. 207035) from the Third Medical Faculty, Charles University.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Srobarova 1150/50, 100 34, Prague 10, Czech Republic

    Jan Zapletal, M. J. Halaska, K. Maxova & L. Rob

  2. Institute of Anatomy, First Faculty of Medicine, Charles University, U Nemocnice 3, 128 00, Prague 2, Czech Republic

    O. Nanka

  3. Institute for the Care of Mother and Child Prague, Third Faculty of Medicine, Charles University, Podolske nabrezi 157, 147 00, Prague, Czech Republic

    L. Hajkova Hympanova & L. Krofta

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  1. Jan Zapletal
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  2. O. Nanka
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Contributions

JZ: project development, data management and collection, figures, manuscript writing, dissection. ON: manuscript writing and editing, data analysis, data collection, dissection. MJH: data analysis, manuscript editing. KM: manuscript editing. LHH: data analysis, manuscript editing. LK: writing—manuscript editing and review. LR: writing—project development, manuscript review.

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Correspondence to Jan Zapletal.

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Zapletal, J., Nanka, O., Halaska, M.J. et al. Anatomy of the pudendal nerve in clinically important areas: a pictorial essay and narrative review. Surg Radiol Anat 46, 211–222 (2024). https://doi.org/10.1007/s00276-023-03285-7

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