Pour aller plus loin sur la névralgie pudendale
Anatomie du nerf pudendal
Le nerf pudendal est un nerf mixte : sensitif des organes génitaux, moteur pour les muscles du périnée, et aussi végétatif.
Le nerf pudendal est une des branches du plexus lombo-sacré, issu des racines nerveuses sacrées de S2 à S4. Accompagné de l’artère et veine pudendales internes, il circule le long du bord antérieur du muscle piriforme avant de pénétrer dans la région fessière. Il se prolonge ensuite dans la pince ligamentaire formée par les ligaments sacro-isciatique et sacro-tubéral sous l’épine ischiatique.
Enfin, il se poursuit dans le canal d’Alcock, qui correspond à un dédoublement de l’aponévrose du muscle obturateur interne, le ligament falciforme.
Consultation
Nouvelle Clinique Bordeaux Tondu
05 56 90 91 16
Clinique Tivoli-Ducos
05 56 11 61 44
Clinique Saint-Anne
05 57 98 05 75
Pôle médical Saint Laurent Médoc
05 56 59 41 07
Cabinet Saint-Loubés
Au cours de ce trajet, trois branches principales émergent :
- Le nerf rectal, qui contribue à la sensibilité de la marge anale et à la motricité du sphincter externe strié de l’anus et rectum.
- Le nerf périnéal, qui assure l’innervation sensitive du périnée, des bourses et de la verge chez l’homme, des grandes lèvres chez la femme, et motrice des muscles ischio et bulbo-caverneux et le sphincter strié de l’urètre.
- Le nerf dorsal de la verge ou du clitoris, participant à l’érection.
Associations de patients
AINP : Association d’Information sur la Névralgie Pudendale et les Douleurs Pelvi-Périnéales
Conférence de consensus d’expert de 2022
Bibliographie
1. Chiarioni G, Asteria C, Whitehead WE. Chronic proctalgia and chronic pelvic pain syndromes: new etiologic insights and treatment options. World J Gastroenterol 2011;17:4447–4455.
2. Labat JJ, Riant T, Robert R, et al. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn 2008;27:306–310.
3. Filler AG. Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery. Neurosurg Focus 2009;26:E9.
4. Soldatos T, Andreisek G, Thawait GK, et al. High-resolution 3-T MR neurography of the lumbosacral plexus. Radiographics 2013;33:967–987.
5. Petchprapa CN, Rosenberg ZS, Sconfienza LM, et al. MR imaging of entrapment neuropathies of the lower extremity. Part 1. The pelvis and hip. Radiographics 2010;30:983–1000.
6. Burge AJ, Gold SL, Kuong S, et al. High-resolution magnetic resonance imaging of the lower extremity nerves. Neuroimaging Clin N Am 2014;24:151–170.
7. Hibner M, Desai N, Robertson LJ, et al. Pudendal neuralgia. J Minim Invasive Gynecol 2010;17:148–153.
8. Hough DM, Wittenberg KH, Pawlina W, et al. Chronic perineal pain caused by pudendal nerve entrapment: anatomy and CT-guided perineural injection technique. Am J Roentgenol 2003;181:561–567.
9. Furtmuller GJ, McKenna CA, Ebmer J, et al. Pudendal nerve 3-dimensional illustration gives insight into surgical approaches. Ann Plast Surg 2014;73:670–678.
10. Follmar KE, Williams EH, Dellon AL. Rectal pain of neural origin: resection of sensory rectal branches of pudendal nerve. J Reconstr Microsurg 2015;31:119–123.
11. Robert R, Prat-Pradal D, Labat JJ, et al. Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surg Radiol Anat 1998;20:93–98.
12. Shafik A, el-Sherif M, Youssef A, et al. Surgical anatomy of the pudendal nerve and its clinical implications. Clin Anat 1995;8:110–115.
13. Pailhe R, Chiron P, Reina N, et al. Pudendal nerve neuralgia after hip arthroscopy: retrospective study and literature review. Orthop Traumatol Surg Res 2013;99: 785–790.
14. Leibovitch I, Mor Y. The vicious cycling: bicycling related urogenital disorders. Eur Urol 2005;47:277–286.
15. Durante JA, Macintyre IG. Pudendal nerve entrapment in an Ironman athlete: a case report. J Can Chiropr Assoc 2010;54:276–281.
16. Popeney C, Ansell V, Renney K. Pudendal entrapment as an etiology of chronic perineal pain: Diagnosis and treatment. Neurourol Urodyn 2007;26:820–827.
17. Fritz J, Chhabra A, Wang KC, et al. Magnetic resonance neurography-guided nerve blocks for the diagnosis and treatment of chronic pelvic pain syndrome. Neuroimag Clin N Am 2014;24:211–234.
18. Benson JT, Griffis K. Pudendal neuralgia, a severe pain syndrome. Am J Obstet Gynecol 2005;192:1663–1668.
19. Prologo JD, Lin RC, Williams R, et al. Percutaneous CTguided cryoablation for the treatment of refractory pudendal neuralgia. Skeletal Radiol 2015;44:709–714.
20. Beco J, Climov D, Bex M. Pudendal nerve decompression in perineology: a case series. BMC Surg 2004;4:15.
21. Shafik A. Pudendal canal syndrome as a cause of vulvodynia and its treatment by pudendal nerve decompression. Eur J Obstet Gynecol Reprod Biol 1998;80:215–220.
22. Thomas C, Lefaucheur JP, Galula G, et al. Respective value of pudendal nerve terminal motor latency and anal sphincter electromyography in neurogenic fecal incontinence. Neurophysiol Clin 2002;32:85–90.
23. Olsen AL, Ross M, Stansfield RB, et al. Pelvic floor nerve conduction studies: establishing clinically relevant normative data. Am J Obstet Gynecol 2003;189:1114–1119.
24. Khoder W, Hale D. Pudendal neuralgia. Obstet Gynecol Clin North Am 2014;41:443–452.
25. Kim S, Choi JY, Huh YM, et al. Role of magnetic resonance imaging in entrapment and compressive neuropathy – what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 1. Overview and lower extremity. Eur Radiol 2007;17:139–149.
26. Zhang Z, Song L, Meng Q, et al. Morphological analysis in patients with sciatica: a magnetic resonance imaging study using three-dimensional high-resolution diffusionweighted magnetic resonance neurography techniques. Spine (Phila Pa 1976) 2009;34:E245–50.
27. Manganaro L, Porpora MG, Vinci V, et al. Diffusion tensor imaging and tractography to evaluate sacral nerve root abnormalities in endometriosis-related pain: a pilot study. Eur Radiol 2014;24:95–101.
28. Kollmer J, Bendszus M, Pham M. MR Neurography: Diagnostic imaging in the PNS. Clin Neuroradiol 2015; 25:283–289.
29. Cejas C, Escobar I, Serra M, et al. High resolution neurography of the lumbosacral plexus on 3T magneteic resonance imaging. Radiologia 2015;57:22–34.
30. Baumer P, Kele H, Kretschmer T, et al. Thoracic outlet syndrome in 3T MR neurography-fibrous bands causing discernible lesions of the lower brachial plexus. Euro Rad 2014;24:756–761.
31. Pham M, Baumer T, Bendszus M. Peripheral nerves and plexus: imaging by MR-neurography and high-resolution ultrasound. Curr Opin Neurol 2014;27:370–379.
32. Del Grande F, Santini F, Herzka DA, et al. Fat-suppression techniques for 3-T MR imaging of the musculoskeletal system. Radiographics 2014;34:217–233.
33. Chhabra A, Carrino JA, Farahani SJ, et al. Whole-body MR neurography: Prospective feasibility study in polyneuropathy and Charcot-Marie-Tooth disease. J Magn Reson Imaging 2016. doi: 10.1002/jmri.25293.
34. Filler A. Magnetic resonance neurography and diffusion tensor imaging: origins, history, and clinical impact of the first 50,000 cases with an assessment of efficacy and utility in a prospective 5000-patient study group. Neurosurgery 2009;65:A29–43.
35. Chhabra A, McKenna CA, Wadhwa V, et al. 3T magnetic resonance neurography of pudendal nerve with cadaveric dissection correlation. World J Radiol 2016;8: 700–706.
36. Baumer P, Weiler M, Bendszus M, et al. Somatotopic fascicular organization of the human sciatic nerve demonstrated by MR neurography. Neurology 2015;84: 1782–1787.
37. Chhabra A, Andreisek G. Magnetic Resonance
Neurography, 1st ed. New Delhi: Jaypee Publications,
2012, pp.161–181.
38. Wadhwa V, Scott KM, Rozen S, et al. CT guided perineural injections for chronic pelvic pain. RadioGraphics 2016;36:1408–1425.
39. Fall M, Baranowski AP, Elneil S, et al. EAU guidelines on chronic pelvic pain. Euro Urol 2010;57:35–48.
40. Weijenborg PT, Greeven A, Dekker FW, et al. Clinical course of chronic pelvic pain in women. Pain 2007;132: S117–23.
41. Robert R, Brunet C, Faure A, et al. [Surgery of the pudendal nerve in various types of perineal pain: course and results]. Chirurgie 1993;119:535–539. (in French).
42. Bautrant E, de Bisschop E, Vaini-Elies V, et al. [Modern algorithm for treating pudendal neuralgia: 212 cases and 104 decompressions]. J Gynecol Obstet Biol Reprod 2003;32:705–712. (in French).
43. Robert R, Labat JJ, Riant T, et al. Neurosurgical treatment of perineal neuralgias. Adv Tech Stand Neurosurg 2007;32:41–59.
44. Rhame EE, Levey KA, Gharibo CG. Successful treatment of refractory pudendal neuralgia with pulsed radiofrequency. Pain Physician 2009;12:633–638.
45. Rey D1, Oderda M. The first case of robotic pudendal nerve decompression in pudendal nerve entrapment syndrome. J Laparoendosc Adv Surg Tech A. 2015 Apr;25(4):319-22.
2. Labat JJ, Riant T, Robert R, et al. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn 2008;27:306–310.
3. Filler AG. Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery. Neurosurg Focus 2009;26:E9.
4. Soldatos T, Andreisek G, Thawait GK, et al. High-resolution 3-T MR neurography of the lumbosacral plexus. Radiographics 2013;33:967–987.
5. Petchprapa CN, Rosenberg ZS, Sconfienza LM, et al. MR imaging of entrapment neuropathies of the lower extremity. Part 1. The pelvis and hip. Radiographics 2010;30:983–1000.
6. Burge AJ, Gold SL, Kuong S, et al. High-resolution magnetic resonance imaging of the lower extremity nerves. Neuroimaging Clin N Am 2014;24:151–170.
7. Hibner M, Desai N, Robertson LJ, et al. Pudendal neuralgia. J Minim Invasive Gynecol 2010;17:148–153.
8. Hough DM, Wittenberg KH, Pawlina W, et al. Chronic perineal pain caused by pudendal nerve entrapment: anatomy and CT-guided perineural injection technique. Am J Roentgenol 2003;181:561–567.
9. Furtmuller GJ, McKenna CA, Ebmer J, et al. Pudendal nerve 3-dimensional illustration gives insight into surgical approaches. Ann Plast Surg 2014;73:670–678.
10. Follmar KE, Williams EH, Dellon AL. Rectal pain of neural origin: resection of sensory rectal branches of pudendal nerve. J Reconstr Microsurg 2015;31:119–123.
11. Robert R, Prat-Pradal D, Labat JJ, et al. Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surg Radiol Anat 1998;20:93–98.
12. Shafik A, el-Sherif M, Youssef A, et al. Surgical anatomy of the pudendal nerve and its clinical implications. Clin Anat 1995;8:110–115.
13. Pailhe R, Chiron P, Reina N, et al. Pudendal nerve neuralgia after hip arthroscopy: retrospective study and literature review. Orthop Traumatol Surg Res 2013;99: 785–790.
14. Leibovitch I, Mor Y. The vicious cycling: bicycling related urogenital disorders. Eur Urol 2005;47:277–286.
15. Durante JA, Macintyre IG. Pudendal nerve entrapment in an Ironman athlete: a case report. J Can Chiropr Assoc 2010;54:276–281.
16. Popeney C, Ansell V, Renney K. Pudendal entrapment as an etiology of chronic perineal pain: Diagnosis and treatment. Neurourol Urodyn 2007;26:820–827.
17. Fritz J, Chhabra A, Wang KC, et al. Magnetic resonance neurography-guided nerve blocks for the diagnosis and treatment of chronic pelvic pain syndrome. Neuroimag Clin N Am 2014;24:211–234.
18. Benson JT, Griffis K. Pudendal neuralgia, a severe pain syndrome. Am J Obstet Gynecol 2005;192:1663–1668.
19. Prologo JD, Lin RC, Williams R, et al. Percutaneous CTguided cryoablation for the treatment of refractory pudendal neuralgia. Skeletal Radiol 2015;44:709–714.
20. Beco J, Climov D, Bex M. Pudendal nerve decompression in perineology: a case series. BMC Surg 2004;4:15.
21. Shafik A. Pudendal canal syndrome as a cause of vulvodynia and its treatment by pudendal nerve decompression. Eur J Obstet Gynecol Reprod Biol 1998;80:215–220.
22. Thomas C, Lefaucheur JP, Galula G, et al. Respective value of pudendal nerve terminal motor latency and anal sphincter electromyography in neurogenic fecal incontinence. Neurophysiol Clin 2002;32:85–90.
23. Olsen AL, Ross M, Stansfield RB, et al. Pelvic floor nerve conduction studies: establishing clinically relevant normative data. Am J Obstet Gynecol 2003;189:1114–1119.
24. Khoder W, Hale D. Pudendal neuralgia. Obstet Gynecol Clin North Am 2014;41:443–452.
25. Kim S, Choi JY, Huh YM, et al. Role of magnetic resonance imaging in entrapment and compressive neuropathy – what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 1. Overview and lower extremity. Eur Radiol 2007;17:139–149.
26. Zhang Z, Song L, Meng Q, et al. Morphological analysis in patients with sciatica: a magnetic resonance imaging study using three-dimensional high-resolution diffusionweighted magnetic resonance neurography techniques. Spine (Phila Pa 1976) 2009;34:E245–50.
27. Manganaro L, Porpora MG, Vinci V, et al. Diffusion tensor imaging and tractography to evaluate sacral nerve root abnormalities in endometriosis-related pain: a pilot study. Eur Radiol 2014;24:95–101.
28. Kollmer J, Bendszus M, Pham M. MR Neurography: Diagnostic imaging in the PNS. Clin Neuroradiol 2015; 25:283–289.
29. Cejas C, Escobar I, Serra M, et al. High resolution neurography of the lumbosacral plexus on 3T magneteic resonance imaging. Radiologia 2015;57:22–34.
30. Baumer P, Kele H, Kretschmer T, et al. Thoracic outlet syndrome in 3T MR neurography-fibrous bands causing discernible lesions of the lower brachial plexus. Euro Rad 2014;24:756–761.
31. Pham M, Baumer T, Bendszus M. Peripheral nerves and plexus: imaging by MR-neurography and high-resolution ultrasound. Curr Opin Neurol 2014;27:370–379.
32. Del Grande F, Santini F, Herzka DA, et al. Fat-suppression techniques for 3-T MR imaging of the musculoskeletal system. Radiographics 2014;34:217–233.
33. Chhabra A, Carrino JA, Farahani SJ, et al. Whole-body MR neurography: Prospective feasibility study in polyneuropathy and Charcot-Marie-Tooth disease. J Magn Reson Imaging 2016. doi: 10.1002/jmri.25293.
34. Filler A. Magnetic resonance neurography and diffusion tensor imaging: origins, history, and clinical impact of the first 50,000 cases with an assessment of efficacy and utility in a prospective 5000-patient study group. Neurosurgery 2009;65:A29–43.
35. Chhabra A, McKenna CA, Wadhwa V, et al. 3T magnetic resonance neurography of pudendal nerve with cadaveric dissection correlation. World J Radiol 2016;8: 700–706.
36. Baumer P, Weiler M, Bendszus M, et al. Somatotopic fascicular organization of the human sciatic nerve demonstrated by MR neurography. Neurology 2015;84: 1782–1787.
37. Chhabra A, Andreisek G. Magnetic Resonance
Neurography, 1st ed. New Delhi: Jaypee Publications,
2012, pp.161–181.
38. Wadhwa V, Scott KM, Rozen S, et al. CT guided perineural injections for chronic pelvic pain. RadioGraphics 2016;36:1408–1425.
39. Fall M, Baranowski AP, Elneil S, et al. EAU guidelines on chronic pelvic pain. Euro Urol 2010;57:35–48.
40. Weijenborg PT, Greeven A, Dekker FW, et al. Clinical course of chronic pelvic pain in women. Pain 2007;132: S117–23.
41. Robert R, Brunet C, Faure A, et al. [Surgery of the pudendal nerve in various types of perineal pain: course and results]. Chirurgie 1993;119:535–539. (in French).
42. Bautrant E, de Bisschop E, Vaini-Elies V, et al. [Modern algorithm for treating pudendal neuralgia: 212 cases and 104 decompressions]. J Gynecol Obstet Biol Reprod 2003;32:705–712. (in French).
43. Robert R, Labat JJ, Riant T, et al. Neurosurgical treatment of perineal neuralgias. Adv Tech Stand Neurosurg 2007;32:41–59.
44. Rhame EE, Levey KA, Gharibo CG. Successful treatment of refractory pudendal neuralgia with pulsed radiofrequency. Pain Physician 2009;12:633–638.
45. Rey D1, Oderda M. The first case of robotic pudendal nerve decompression in pudendal nerve entrapment syndrome. J Laparoendosc Adv Surg Tech A. 2015 Apr;25(4):319-22.
46. Levesque A, Bautrant E, Quistrebert V, et al. Recommendations on the management of pudendal nerve entrapment syndrome: A formalised expert consensus. Eur J Pain. 2022;26:7–17.