Technique of pudendal Nerve Localization for Block or Stimulation

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Abstract
A diagnostic technique is described for study of the pudenal nerve via a dorsal rather than perineal approach. The method offers unique advantages for the urodynamic study of sphincteric function. The patient is placed in the prone position with slight flexion of the hips. The position of the ischial spine is identified topographically using the ischial tuberosities, greater trochanter and lower edge of the ischial-tuberous ligament. Local anesthesia and electrical stimulation then are used to position a needle tip adjacent to the pudenal nerve. This approach allows for specific localization of the nerve for accurate temporary or permanent nerve block. It also permits continuous urodynamic monitoring of pelvic floor behavior with stimulation of the pudenal nerve to assess functional integrity of the nerve and the pelvic floor striated muscles.