[The pudendal nerve: clinical and therapeutic morphogenesis, anatomy, and physiopathology].
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.
Robert
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R
Service de neurotraumatologie, Hôtel-Dieu, 2, place Alexis-Ricordeau, 44035 Nantes cedex 1, France. roger.robert@chu-nantes.fr
Labat
J-J
JJ
Riant
T
T
Louppe
J-M
JM
Hamel
O
O
D004568:Electrodiagnosis; D006801:Humans; D008160:Lumbosacral Plexus / Q000033:anatomy & histology; D009408:Nerve Compression Syndromes / Q000473:pathology / Q000503:physiopathology; D009460:Neurologic Examination; D019635:Neurosurgical Procedures; D010502:Perineum / Q000294:innervation* / Q000473:pathology; D010525:Peripheral Nerves / Q000033:anatomy & histology* / Q000503:physiopathology / Q000601:surgery; D010523:Peripheral Nervous System Diseases / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D013126:Spinal Nerve Roots / Q000473:pathology / Q000503:physiopathology