Pudendal canal: Surgical anatomy and clinical implications

The anatomy of the pudendal canal (PC) was studied in 26 cadavers: 10 still born and 16 adults (mean age, 48.2 years). Two approaches were used to expo se the PC: gluteal and perineal. The PC was an obliquely lying tube with a mean length of 0.8 cm in the stillborn and 1.6 cm in the adult cadavers. It started at a mean distance of 0.8 cm from the ischial spine in the stillbo rn and of 1.6 cm in the adult cadavers, and ended at a mean distance of 0.7 cm and 2.6 cm, respectively, from the lower border of the symphysis pubis. The PC wall was formed by the splitting of the obturator fascia and not by the lunate fascia. The PC contained the pudendal nerve and vessels embedde d in loose areolar tissue. The three branches of the neurovascular bundle a rose inside the canal in all but three cadavers. The wall of the PC consist ed of collagen and elastic fibers, whereas that of the obturator fascia con sisted of collagen only. The PC seems to be structurally adapted to serve c ertain functions. The criss-cross textile arrangement of collagen fibers in its wall allows the canal to change its shape in response to changes in pu dendal vessels that occur during sexual activity. The elastic recoil may no t only help to "pump" the blood up the pudendal vein, but also to prevent P C subluxation. The PC may, furthermore, act as a "pulley" for the neurovasc ular bundle. The pulley action may be disrupted by disordered pelvic floor muscles or defecation. Knowledge of the precise anatomy of the PC is necess ary to carry out PC decompression in the treatment of PC syndrome.