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Diseases of the Peripheral Nerve and Mononeuropathies
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Diana Mnatsakanova, Charles K. Abrams
Courses anteriorly along the intrapelvic wall within a tunnel in the dense obturator fascia and divides into three branches: The inferior rectal nerve supplies the external anal sphincter, the perianal skin, and the mucosa of the lower anal canal.The perineal nerve innervates the muscles of the perineum, the erectile tissue of the penis, the external urethral sphincter, the distal part of the mucous membrane of the urethra, and the skin of the perineum and labia/scrotum.The dorsal nerve of the clitoris/penis supplies the corpus cavernosum then courses forward on the dorsum of the clitoris/penis to innervate the skin, prepuce, and glans.
Considerations for the Focused Neuro-Urologic History and Physical Exam
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Laura L. Giusto, Patricia M. Zahner, Howard B. Goldman
With the patient in the lithotomy position, one should observe the presence or absence of any indwelling catheters. During bimanual exam using well-lubricated fingers, palpate all portions of the vagina to assess for pelvic floor pain and muscle tension. Ask the patient to contract the pelvic floor and note whether the contraction is strong, medium, weak, or absent. Pelvic floor muscle contraction is mediated by the perineal nerve. A half speculum is then inserted into the vagina to assess for pelvic organ prolapse, vaginal atrophy, bleeding, or discharge. The patient is asked to cough to demonstrate if she has stress urinary incontinence or urethral hypermobility.
Conservative Treatment of Fecal Incontinence
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
For clinical and therapeutical use, three groups of fecal incontinence should be differentiated according to the etiology of incontinence. Idiopathic fecal incontinence without other symptoms or history of anal damage is the most common form of fecal incontinence. This form of incontinence is caused by a neuropathy of the pudendal and/or perineal nerves.1–3
Diagnosis and treatment of pudendal and inferior cluneal nerve entrapment syndrome: a narrative review
Published in Acta Chirurgica Belgica, 2022
Katleen Jottard, Pierre Bonnet, Viviane Thill, Stephane Ploteau, Stefan de Wachter
The PN has been referred to as the king of the perineum [3]. Indeed, the PN plays a major role in the fecal and urinary continence mechanisms and is important for normal sexual functioning. The PN has both motor and sensory functions and carries sympathetic fibers. It arises from the second, third, and fourth sacral ventral rami at the inferior edge of the piriformis muscle [4]. Before entering the gluteal region, the nerve passes through the infrapiriformis foramen, which is a part of the greater sciatic foramen. The nerve then passes posterior from the ischial spine or sacrospinous ligament (SSL), medial to the internal pudendal vessels, to finally enter the perineum through the Alcock’s canal, a fold of the obturator internus muscle fascia. It continues to course through the pudendal canal (Alcock’s canal), giving off three consecutive branches on its path: the inferior rectal (anal) nerve and its branches, the perineal nerve and its branches and the dorsal nerve of the penis or clitoris.
The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review
Published in Journal of Investigative Surgery, 2021
Michael G. Fadel, Laura Peltola, Gianluca Pellino, Gabriela Frunza, Christos Kontovounisios
The pudendal nerve is a mixed sensory and motor nerve that arises from S2, S3 and S4 nerve roots in the sacral plexus [1]. It exits the pelvis through the greater sciatic foramen and reenters the perineum to course through the ischiorectal fossa and Alcock’s canal. Here, the pudendal nerve accompanies the pudendal blood vessels and divides into three branches: inferior rectal nerve, perineal nerve, and the dorsal nerve of the clitoris or penis. The pudendal nerve provides innervation to the urethral muscles, clitoris, penis, perineum and pelvic floor sphincter, urethra and bladder triangle [2, 3].
Non-transecting urethroplasty in patients with bulbar urethral strictures shorter than three centimeters
Published in Scandinavian Journal of Urology, 2023
Muhammet Şahin Yılmaz, Alihan Kokurcan, Fahrettin Şamil Uysal, Görkem Özenç, Fatih Yalçınkaya
In addition, shortening of the urethra after EPA is performed in cases with long urethral strictures may lead to penile curvature or chordee. Mobilization of the spongiosum during primary anastomosis and transection may impair the caudal blood flow and lead to weak tumescence or cold glans during erection at the postoperative period [21,22]. It is also known that injury of the perineal nerves responsible for the sensory innervation of the perineum, scrotum, and ventral surface of the penile shaft may cause genital sensitivity disorders [23].