Shafik A, Doss S
Department of Surgery and Experimental Research, Cairo University, Egypt.
J Urol. 1999 Jan;161(1):85-9.
The gross anatomy of the pudendal nerve branches was studied to identify more precisely the neuroanatomical relationship in the region of the anal canal, bladder neck and proximal urethra. Such knowledge is essential for the development of surgical techniques that avoid nerve injury in sphincteroplasty for anal and urinary stress incontinence, and in pudendal canal decompression.
The pudendal nerve terminal branches were dissected in 7 female and 5 male formalin fixed cadavers, including 6 fully mature neonates and 6 adults, a mean age of 37.6 years. The nerves were traced from the pudendal nerve to their termination in the anal and urethral sphincters, and pelvic floor muscles.
The inferior rectal nerve occupied the lower half of the ischiorectal fossa. Immediately after emerging from the pudendal canal it extended a motor branch to the levator ani muscle and the cutaneous perianal and scrotal branches. The nerve terminated in the external anal sphincter at the 3 and 9 o'clock positions. Inside the pudendal canal the perineal nerve gave rise to a scrotal branch which joined the scrotal branch of the inferior rectal nerve to form the common scrotal nerve. About 2 to 3 cm. from the pudendal canal the perineal nerve extended a branch to the bulbocavernosus muscle and divided into the terminal scrotal and motor branches, which penetrated the striated urethral sphincter at the 3 and 9 o'clock positions. The deep dorsal nerve of penis or clitoris coursed forward into the ischiorectal fossa, emerged from the deep perineal pouch and penetrated the suspensory ligament to the dorsum of the penis or clitoris.
The identification of the precise anatomical relation of the somatic nerve termination to the anal and urethral sphincters seems vital to avoid sphincter denervation during surgery for the correction of fecal and stress urinary incontinence.
研究阴部神经分支的大体解剖结构，以更精确地确定肛管、膀胱颈和尿道近端区域的神经解剖关系。这些知识对于开发避免在肛门和尿失禁括约肌成形术以及阴部管减压术中神经损伤的手术技术至关重要。
在7具女性和5具男性福尔马林固定尸体中解剖阴部神经终末分支，包括6例完全成熟的新生儿和6例成年人，平均年龄37.6岁。追踪神经从阴部神经到其在肛门和尿道括约肌以及盆底肌肉中的终末部位。
直肠下神经占据坐骨直肠窝的下半部。从阴部管穿出后立即发出一支运动支至肛提肌以及肛周和阴囊皮肤分支。该神经在3点和9点位置终止于肛门外括约肌。在阴部管内，会阴神经发出一支阴囊支，该阴囊支与直肠下神经的阴囊支汇合形成阴囊总神经。在距阴部管约2至3厘米处，会阴神经发出一支至球海绵体肌的分支，并分为终末阴囊支和运动支，它们在3点和9点位置穿透尿道横纹括约肌。阴茎或阴蒂背深神经向前进入坐骨直肠窝，从会阴深袋穿出并穿透阴茎或阴蒂背侧的悬韧带。
确定躯体神经终末与肛门和尿道括约肌的精确解剖关系对于在矫正大便失禁和压力性尿失禁的手术中避免括约肌去神经支配似乎至关重要。
