Olga M. Kalinkin MD, Abstract Co-Author: Nothing to Disclose

Michael Hibner MD, PhD, Abstract Co-Author: Nothing to Disclose

Sara Panahandeh Raymond MD, Presenter: Nothing to Disclose

Eric C. Umstead MD, Abstract Co-Author: Nothing to Disclose

Aaron Braun MD, Abstract Co-Author: Nothing to Disclose

To identify the patients eligible for surgical pudendal nerve decompression with macroanatomical causes of pudendal nerve entrapment. Pudendal neuralgia is a multifactorial condition and can be caused by mechanical injury to the nerve (“entrapment”), viral infection, or immunologic processes

40 patients (11 men and 29 women) with pudendal neuralgia aged 28 to 65 were evaluated with the dedicated MRI pudendal nerve protocol with and without contrast material. Pudendal neurovascular bundle was screened for presence of the pathology along its course in the lumbar-sacral plexus, the lesser sciatic foramen, the interligamentous space and Alcock’s canal. Neurovascular bundles of the perineal, the rectal and the dorsal nerve of penis or clitoris were readily identified on the postcontrast MRI sequences.

We found four (10%) patients with pudendal nerve entrapment with scarring along the course of the pudendal nerve in  the interligamentous space, Alcock’s canal. These patients were treated with the pudendal nerve release. In another two patients the dilated veins in the inteligamentous space and Alcock’s canal were seen. All other patients reveal no pathology along the course of the pudendal neurovascular bundle or branches. Significant pathology requiring other treatment was identified in 5 patients (metastatic bone disease – 1 patient, pelvis congestion syndrome- 2 patients, pelvic floor laxity-1 patient).

MRI is a powerful screening tool in identification of the patients with anatomical causes of the pudendal nerve entrapment to be treated with surgery. Patients with no anatomical causes of the pudendal nerve entrapment on MRI can be further stratified for physical therapy or CT- guided injections to the nerve.

MR imaging can be used to delineate the anatomical causes of entrapment of the pudendal nerve and guide the physician for treatment planning.

Kalinkin, O, Hibner, M, Panahandeh Raymond, S, Umstead, E, Braun, A, MRI of the Pudendal Nerve in the Patients with Pudendal Neuralgia.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11013064.html