Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

11. Groin Pain Etiology: Pudendal Neuralgia
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clinical practice, this number seems inflated; approximately 30–40 % of
our patients experience long-term relief with the addition of steroids to
the nerve injection.
Surgical Treatment Approach
Transgluteal Pudendal Neurolysis Transgluteal pudendal neurolysis
is currently the most common procedure performed for surgical decompression
of the pudendal nerve. It allows surgeons to access the region
between the sacrospinous and sacrotuberous ligaments in order to visualize
the longest segment of the pudendal nerve. This is also a common
area for pudendal nerve compression [ 20 ].
To perform this operation, the patient is placed in the prone, jackknife
position. An incision is made on the buttock of the affected side, immediately
over the sacrotuberous ligament. The area is dissected until the
ligament is identified and the space between the sacrotuberous and sacrospinous
ligaments is found, revealing the pudendal neurovascular bundle
(Fig. 11.4 ). The initial dissection is usually difficult, particularly in
patients who have significant scarring in this area, who have undergone
previous operation in the area, or who experience thinning of the nerve.
Piriformis muscle
Sacrotuberous
ligament (cut)
Ischium with ischial
spine
Sacrospinous
ligament
Entry to obturator
(Alcock’s) canal
Obturator internus
muscle
Sacrotuberous
ligament (cut)
Fig. 11.4. View of the left pudendal nerve during transgluteal pudendal neurolysis.
Patient is in prone jackknife position.