65 - Pudendal Nerve Anatomical Variations: Exploring Implications in the Landscape of Pelvic Disorders

Poster Board Number: 65
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Odd poster #s – first hour
Even poster #s – second hour

Co-authors:

Radhika Patel - Sam Houston State University College of Osteopathic Medicine; Peggy Taylor - Sam Houston State University College of Osteopathic Medicine; Jaime Hinojosa - Sam Houston State University College of Osteopathic Medicine; Maryvi González-Solá - Parker University; Everett Johnson - Parker University; Jailenne Quiñones-Rodríguez - Sam Houston State University College of Osteopathic Medicine

Abstract Body : Pelvic vasculature has been found to have significant anatomical variations both in the branching patterns and the distribution of the nerves throughout the pelvis. Variations in the course of the pudendal nerve (PN) can occur in terms of its course, branching pattern, or the presence of accessory pudendal nerves. Therefore, they can contribute to pelvic pain and other related issues, including an increased risk of entrapment, which can cause pudendal nerve dysfunction. PN dysfunction has been associated with gynecological conditions such as pudendal neuralgia and vulvodynia. This research aims to evaluate the frequency of PN anatomical variations in cadavers and their subsequent impact on the outcome of pelvic disorders.

Forty embalmed female cadavers (80 hemipelves) were dissected and examined from the Willed Body Program at the University of Texas McGovern Medical School. Detailed pelvis dissections were performed with an anterior and posterior approach. From the anterior approach, measurements were obtained in millimeters (mm) of S2, S3, and S4 ventral roots length, lumbosacral trunk width, and PN length from origin to where it exits the greater sciatic foramen and width. Afterward, PN length and width measurements were taken from the posterior approach before entering the pudendal canal. Anatomical lumbosacral trunk and pudendal nerve variants were also documented during dissection. Photographs of all dissections were taken for documentation. Measurements were tabulated, and descriptive statistics were used for data analyses and reporting.

Understanding variations of the pudendal nerve in both the origin and course is crucial to evaluate if a relationship exists between variations and gynecologic disorders such as pudendal neuralgia. It was not statistically significant compared to the nerve’s origin and distribution measurements. However, the PN distribution and width from the anterior approach were significantly increased (p< 0.0001) compared to the posterior approach. PN anatomical variations can contribute to nerve entrapment or compression, leading to symptoms such as pain, numbness, or dysfunction in the pelvic region.

Identifying specific variations helps in understanding potential sites of compression and planning interventions. Diagnosing pudendal nerve-related pelvic pain can be challenging and often requires a comprehensive assessment by healthcare professionals. Imaging studies, such as magnetic resonance imaging (MRI), may be used to visualize the anatomy and identify potential anatomical variations.