The entrapment of dorsal nerve of penis/clitoris under the pubis: an alternative source of pudenal neuralgia.

The article of Peng and Tumber (1) nicely reviewed current knowledge about ultrasound-guided interventional procedures for patients with piriformis syndrome, border nerve syndrome, and pudendal neuralgia. In the case of pudendal neuralgia, they stated that pudendal nerve entrapment syndrome might be caused either by the pudendal nerve entrapment between the sacrotuberous and the sacrospinous ligament or inside the Alcock ́s canal (1). However, current research of this topic showed there is another possible site of pudendal nerve entrapment — the compression of the dorsal nerve of the penis/clitoris against the lower border of the pubic bone, where the nerve runs in a close proximity to the bone, in the sulcus nervi dorsalis penis/clitoridis (2-6). The nerve entrapment in this site might mimic the clinical picture of the 2 above mentioned “typical” types of pudendal nerve entrapment syndromes and thus cause a diagnostic challenge (7). Although the first report of this syndrome comes from 1981 (8) and from that time this syndrome has been extensively studied, some aspects are still not known. Most importantly, no diagnostic algorithm to distinguish between particular types of pudendal nerve entrapment syndromes has been developed yet. I believe ultrasound might be very helpful in differential diagnosis of dorsal nerve entrapment in the future. Possibly, it might be helpful in evaluation of the degree of fibroplasia around the nerve. An ultrasound-guided dorsal nerve block might also be helpful to distinguish between entrapments of the dorsal nerve of the penis/clitoris and pudendal nerve trunk. Moreover, it might be also helpful in treatment of dorsal nerve syndrome.