title: Anatomic relationship between the spermatic cord and the pubic tubercle: are our clamps injuring the cord during symphyseal repair?
abstract: OBJECTIVE
  Traditional repair of the disrupted pubic symphysis includes application of pointed clamps to the pubic tubercles and/or pubic body for fracture reduction. Recent studies have reported rates of sexual dysfunction of 42%-90% after repair of these injuries. The purpose of this study is to define the anatomy of the spermatic cord relative to the pubic tubercle and other local structures to assess the risk of sustaining an iatrogenic injury during clamp placement.
  
  
  METHODS
  Eight intact lower-half fresh male human cadavers were dissected. A window of skin and subcutaneous tissue was excised to expose the low abdominal wall and penile root. Pubic tubercles were identified by palpation and marked. The spermatic cord was identified at the superficial inguinal ring and followed into the scrotum, and any anatomical abnormalities were recorded. The relationship and distance of the spermatic cord to the pubic tubercle, insertion of the inguinal ligament and abdominal wall musculature, and pubic symphysis were recorded. Photographs were taken of the superficial and deep anatomy.
  
  
  RESULTS
  Spermatic cords were found to follow a consistent course after exiting the inguinal canal at the lower abdomen: they coursed inferior and medial to a position lateral to the pubic tubercles. In all cases, the spermatic cord lay adjacent, directly lateral to the tubercle with an average separation of 0.8 mm (range, 0-2 mm). The average distances from the lateral aspect of the tubercle and the medial border of the spermatic cord to the pubic symphysis were 26 and 27 mm, respectively. Qualitatively, even with direct visualization, it was not feasible to apply a pointed tenaculum to the pubic tubercles without piercing the spermatic cord, unless one manually retracted the latter.
  
  
  CONCLUSIONS
  The spermatic cord is located lateral and immediately adjacent to the pubic tubercle after it exits the inguinal canal and passes into the scrotum. As such, the spermatic cord seems to be at a significant risk of sustaining injury when pointed forceps are placed on the tubercles, as is often recommended during the repair of pubic diastasis.
authors.affiliation: *Texas Health Harris Methodist Hospital, Fort Worth, TX; and †San Antonio Military Medical Center, San Antonio, TX.
authors.forename: Cory A
authors.initials: CA
authors.lastname: Collinge
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beltran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D050723:Fractures, Bone / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D010384:Pelvic Bones / Q000033:anatomy & histology* / Q000601:surgery*; D013085:Spermatic Cord / Q000033:anatomy & histology* / Q000293:injuries*