Le nerf pudendal : morphogenèse,anatomie, physiopathologie,clinique et thérapeutique |
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Authors: | R Robert J-J Labat T Riant J-M Louppe O Hamel |
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Institution: | 1. Vascular and Interventional Radiology Department, Hospital Italiano de Buenos Aires, JD Peron 4190, Ciudad de Buenos Aires C1181ACH, Argentina;2. Department of Anatomy, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina;1. Département de gynécologie, hôpital Jeanne-de-Flandre, université Lille Nord-de-France, CHRU de Lille, 59000 Lille, France;2. Département d’anesthésie-réanimation, hôpital Jeanne-de-Flandre, université Lille Nord-de-France, CHRU de Lille, 59000 Lille, France;3. Département de biostatistique, hôpital Jeanne-de-Flandre, université Lille Nord-de-France, CHRU de Lille, 59000 Lille, France;1. Anatomical Institute I, University of Cologne, Germany;2. Praxis “Med 360 Grad”, Burger Straße 213, 42859 Remscheid, Germany;3. Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Straße 170, 56072 Koblenz, Germany;4. Department of Neurosurgery, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany |
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Abstract: | The pudendal is the king of the perineum. Most often originating in the S3 root, it is responsible for the teguments of the perineum (glans penis, clitoris, scrotum, and the labia majora, the skin of the central fibrous perineal body, anus), but also the erector muscles and the striated sphincters. The social nerve, it controls erection and the voluntary sphincters. It is also the nerve of the beginnings of sexual sensation and masturbation. Its injury is expressed in perineal pain, which, when positional, suggests a tunnel syndrome. The compression points have become well known: ligament pinching between the sacrotuberous and sacrospinous ligaments, the falciform process and the pudendal canal (Alcock canal). The data from questioning the patient, the results of the neurological exam, and the at least momentary response to infiltration define the Nantes criteria, which confirm the diagnosis. Treatment is medical, physical therapy, infiltration, and, as a last resort, surgery. The results have improved because of new technical norms, with 75% of operated patients benefiting from surgery. This disorder has become well known and should be remembered, thus sparing the patient from years of suffering and needless consultations for patients who do not present with organ disease, too often implicated instead of a true canal neuropathy, whose clinical manifestation and treatment have now been validated. |
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