Real-time nerve mapping for endometriosis involving the sciatic and pudendal nerves.

Anatomy of the Pudendal Nerve and Other Neural Structures Around the Proximal Hamstring Origin in Males

Composition and central projections of the pudendal nerve in the rat investigated by combined peptide immunocytochemistry and retrograde fluorescent labelling

Sacral Foraminal (S2-3) Radiculopathy Syndrome (SFRS): Identification of a New PGAD/GPD Trigger in the Cauda Equina

Activation of Somatosensory Afferents Elicit Changes in Vaginal Blood Flow and the Urethrogenital Reflex Via Autonomic Efferents

Aim Restoration of bladder and bowel continence after pudendal nerve anastomosis has been shown successfully in animal models and may be applicable in humans. Aim of this cadaveric study was to assess feasibility of pudendal nerve neurotization using motor fascicles from sciatic nerve. Methods Pudendal and sciatic nerves were exposed via gluteal approach in 5 human cadavers (10 sites). Size of pudendal and sciatic nerves and the distance between two nerves was measured. Results There were four male and one female cadavers. Mean age was 62 (range, 50–70) years. Mean pudendal nerve diameter was 2.94 mm (right side) and 2.82 mm (left side). Mean sciatic nerve diameter was 11.2 mm (right side) and 14.2 mm (left side). The distance between two nerves was 23.4 mm on both sides. Conclusion Transfer of the motor fascicles from sciatic nerve to pudendal nerve to restore the bladder and bowel continence is feasible.

Neurologic dysfunction causes fecal incontinence, but current techniques for its assessment are limited and controversial. The purpose of this work was to investigate spino-rectal and spino-anal motor-evoked potentials simultaneously using lumbar and sacral magnetic stimulation in subjects with fecal incontinence and healthy subjects and to compare motor-evoked potentials and pudendal nerve terminal motor latency in subjects with fecal incontinence. This was a prospective, observational study. The study took place in 2 tertiary care centers. Subjects included adults with fecal incontinence and healthy subjects. Translumbar and transsacral magnetic stimulations were performed bilaterally by applying a magnetic coil to the lumbar and sacral regions in 50 subjects with fecal incontinence (1 or more episodes per week) and 20 healthy subjects. Both motor-evoked potentials and pudendal nerve terminal motor latency were assessed in 30 subjects with fecal incontinence. Stimulation-induced, motor-evoked potentials were recorded simultaneously from the rectum and anus with 2 pairs of bipolar ring electrodes. Latency and amplitude of motor-evoked potentials after lumbosacral magnetic stimulation and agreement with pudendal nerve terminal motor latency were measured. When compared with control subjects, 1 or more lumbo-anal, lumbo-rectal, sacro-anal, or sacro-rectal motor-evoked potentials were significantly prolonged (p < 0.01) and were abnormal in 44 (88%) of 50 subjects with fecal incontinence. Positive agreement between abnormal motor-evoked potentials and pudendal nerve terminal motor latency was 63%, whereas negative agreement was 13%. Motor-evoked potentials were abnormal in more (p < 0.05) subjects with fecal incontinence than pudendal nerve terminal motor latency, in 26 (87%) of 30 versus 19 (63%) of 30, and in 24% of subjects with normal pudendal nerve terminal motor latency. There were no adverse events. Anal EMG was not performed. Translumbar and transsacral magnetic stimulation-induced, motor-evoked potentials provide objective evidence for rectal or anal neuropathy in subjects with fecal incontinence and could be useful. The test was superior to pudendal nerve terminal motor latency and appears to be safe and well tolerated.

(071) SEXUAL DYSFUNCTIONS SECONDARY TO LUMBOSACRAL ANNULAR TEAR-INDUCED SACRAL RADICULOPATHY: “GENITO-PELVIC SCIATICA”

Endometriosis is a prevalent gynecological disorder in women of reproductive age. It is the leading cause of chronic pelvic pain. While the mechanisms underlying this pain remain elusive, rare cases of pelvic nerve involvement can result in severe, debilitating symptoms, adding complexity to the clinical landscape. Nerve involvement typically results from the direct extension of deep infiltrating endometriosis, though it may also occur in isolation. The nerves most commonly affected include the inferior hypogastric and lumbosacral plexuses, as well as the sciatic, pudendal, obturator, and femoral nerves. Early and accurate diagnosis is essential for the effective management of the pain and the prevention of irreversible nerve damage. Given the limitations of transvaginal ultrasonography in visualizing the lateral compartment, MRI is considered the gold standard for detecting and evaluating pelvic nerve involvement. Through the use of optimized protocols to enhance the visualization of nerves and their anatomical landmarks, radiologists play a key role in the identification of endometriotic lesions. A comprehensive and structured radiology report is essential for surgical planning, as nerve involvement often requires precise interventions to alleviate symptoms and restore quality of life.Critical relevance statementAccurate identification and a structured reporting of pelvic nerve endometriosis in the lateral compartment are pivotal to guide surgical decision-making and optimize patient outcomes.Key PointsPelvic nerve endometriosis is often overlooked, underestimated by clinicians, and underdiagnosed on imaging.Timely nerve involvement diagnosis prevents permanent damage in pelvic pain with neurological symptoms.Deep endometriosis in the lateral compartment may extend to the pelvic nerves.The inferior hypogastric plexus, sacral plexus, sciatic, and pudendal nerves are commonly affected.A dedicated MRI protocol with 3D T2-weighted sequence ensures accurate pelvic nerve assessment.Graphical

(022) SEXUAL DYSFUNCTION DUE TO LUMBOSACRAL RADICULOPATHY

Pelvic Neuroanatomy Learning from Fresh Frozen Cadaveric Dissections: Overview of Commonly Encountered Pelvic Nerves in Neuropelveology

Anatomical Relationships of the Sciatic Nerve and Pudendal Nerve to the Ischial Spine as They Exit the Greater Sciatic Foramen

Excision of Deep Endometriosis Nodules of the Sciatic Nerve in 10 Steps

Pelvic Nerves in Laparoscopy: A Review of Anatomy and Approach to Dissection

P491: Reversible intraoperative neurophysiologic monitoring changes associated with surgical retraction

Chronic pelvic pain is a disabling condition that affects a large number of men and women. It may occur after a known inciting event, or it could be idiopathic. A common cause of pelvic pain syndrome is neuropathy of the pelvic nerves, including the femoral and genitofemoral nerves, ilioinguinal and iliohypogastric nerves, pudendal nerve, obturator nerve, lateral and posterior femoral cutaneous nerves, inferior cluneal nerves, inferior rectal nerve, sciatic nerve, superior gluteal nerve, and the spinal nerve roots. Pelvic neuropathy may result from entrapment, trauma, inflammation, or compression or may be iatrogenic, secondary to surgical procedures. Imaging-guided nerve blocks can be used for diagnostic and therapeutic management of pelvic neuropathies. Ultrasonography (US)-guided injections are useful for superficial locations; however, there can be limitations with US, such as its operator dependence, the required skill, and the difficulty in depicting various superficial and deep pelvic nerves. Magnetic resonance (MR) imaging-guided injections are radiation free and lead to easy depiction of the nerve because of the superior soft-tissue contrast; although the expense, the required skill, and the limited availability of MR imaging are major hindrances to its widespread use for this purpose. Computed tomography (CT)-guided injections are becoming popular because of the wide availability of CT scanners, the lower cost, and the shorter amount of time required to perform these injections. This article outlines the technique of perineural injection of major pelvic nerves, illustrates the different target sites with representative case examples, and discusses the pitfalls. (©)RSNA, 2016.