The purpose of this study was to assess the accuracy of US-guided injections of the pudendal nerve at the ischial spine and Alcock’s canal levels. Indeed, there are no cadaveric studies evaluating injection accuracy at the ischial spine and none drawing a comparison between the two locations. The literature concerning the accuracy of the injections is very scarce. A successful nerve block points toward a diagnosis of PNE and can contribute to ruling out non-neuropathic causes of perineal pain. Blockade of the nerve using US guidance has been described at the levels of the ischial spine and Alcock’s canal. Ultrasound imaging of pudendal nerves has been carried out at the level of the ischial spine and Alcock’s canal, as well as at the transperineal level. Moreover, several patients suffered entrapment at several locations. In 70% of cases, the locus of entrapment was situated at the ischial spine, while nerve compression in Alcock’s canal was demonstrated in 40% of cases. Furthermore, another study of 100 patients diagnosed with pudendal neuralgia according to the Nantes criteria, including 24 bilateral cases, reported a very different prevalence. Notably, the MRI findings reported in this and other studies have yet to prove their clinical correlation with PNE. The imaging criteria were defined as evidence of nerve edema, and asymmetry of the piriformis and obturator internus muscles were compared with the contralateral side. Other entrapment locations included the sciatic notch (2%), the ischial spine (4.8%), and the distal branches of the nerve (13%). A prospective study evaluating 200 patients, whose diagnostic criteria were based on history, clinical examination, imaging, and clinical response to magnetic resonance imaging (MRI)–guided selective block, found that in a vast majority of the cases (79.9%), the zone of entrapment was located in Alcock’s canal on the medial surface of the obturator internus muscle. Depending on the studies, the prevalence of the exact location of the entrapment varies. PNE has been described at four different locations (Alcock’s canal on the medial surface of the obturator internus muscle, sciatic notch, ischial spine, and distal branches of the nerve), but the entrapment location does not significantly alter the presenting symptoms. The pudendal nerve is shown, with the key surrounding structures of the right buttock labeled. Urinary frequency and/or pain on a full bladderĭyspareunia and/or pain after sexual intercourse Pain referred to the medial aspect of the thigh Imaging abnormalities able to account for the painĪssociated signs not excluding the diagnosis Presence of exquisite tenderness on palpation of the ischial spineĬlinical neurophysiology findings in men or nulliparous womenĮxclusively coccygeal, gluteal, pubic, or hypogastric pain Rectal or vaginal foreign body sensation (sympathalgia) Pain relieved by diagnostic pudendal nerve blockīurning, shooting, or stabbing pain, numbness Pain with no objective sensory impairment The pain does not wake the patient at night Pain is predominantly experienced while sitting Pain in the territory of the pudendal nerve: from the anus to the penis or clitoris
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