Benjamin Alcock and the Pudendal Canal

ABSTRACT

The anatomy of the pudendal nerve is complex and difficult to visualize. Entrapment of the pudendal nerve is believed to occur in a canal, the pudendal canal or Alcock's canal, yet in the literature this term is used to refer to several different anatomic locations. We present a brief history of Benjamin Alcock, and we compare Alcock's original description of the pudendal canal with our findings from a cadaveric study. It is concluded that Alcock's canal for the pudendal nerve, as Alcock described it related to the pudendal artery, should be that portion of the pudendal nerve within the obturator internus fascia. This definition now permits future medical and surgical approaches to use the appropriate terminology for this anatomic location.

KEYWORDS

Alcock's canal - pudendal nerve - pudendal nerve entrapment

REFERENCES

• 1 O'Rahilly R. Benjamin Alcock: The first Professor of Anatomy and Physiology in Queen's College, Cork.  Ir J Med Sci. 1948;  22 622-632
• 2 Alcock B. Iliac arteries. In: Todd R B, (Ed.). The Cyclopaedia of Anatomy and Physiology. Vol. 2. London: Longman, Brown, Green, and Longmans; 1836: 834-835
• 3 Davis G G. The male perineum. In: Applied Anatomy: The Construction of the Human Body Considered in Relation to Its Functions; Diseases and Injuries. Philadelphia: J.B. Lippincott Company; 1913
• 4 Agur A MR, Lee M J. Grant's Atlas of Anatomy. 10th ed. Baltimore, MD: Williams & Wilkins Publishing; 1999: 217
• 5 Shafik A. Pudendal artery syndrome with erectile dysfunction: treatment by pudendal canal decompression.  Arch Androl. 1995;  34 83-94
• 6 Shafik A. Role of pudendal canal syndrome in the etiology of fecal incontinence in rectal prolapse.  Digestion. 1997;  58 489-493
• 7 Filler A G. Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery.  Neurosurg Focus. 2009;  26 E9
• 8 Hruby S, Ebmer J, Dellon A L, Aszmann O C. Anatomy of pudendal nerve at urogenital diaphragm—new critical site for nerve entrapment.  Urology. 2005;  66 949-952
• 9 Robert R, Labat K K, Bensignor M, Glemain P, Deschamps C, Raoul S, Hamel O. Decompression and transposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation.  Eur Urol. 2005;  47 403-408
• 10 Hruby S, Dellon L, Ebmer J, Höltl W, Aszmann O C. Sensory recovery after decompression of the distal pudendal nerve: anatomical review and quantitative neurosensory data of a prospective clinical study.  Microsurgery. 2009;  29 270-274
• 11 Loukas M, Louis Jr R G, Tubbs R S, Wartmann C, Colborn G L. Intra-abdominal laparoscopic pudendal canal decompression—a feasibility study.  Surg Endosc. 2008;  22 1525-1532
• 12 Achtari C, McKenzie B J, Hiscock R et al.. Anatomical study of the obturator foramen and dorsal nerve of the clitoris and their relationship to minimally invasive slings.  Int Urogynecol J Pelvic Floor Dysfunct. 2006;  17 330-334
• 13 Mahakkanukrauh P, Surin P, Vaidhayakarn P. Anatomical study of the pudendal nerve adjacent to the sacrospinous ligament.  Clin Anat. 2005;  18 200-205
• 14 Robert R, Labat J J, Bensignor M et al.. Decompression and transposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation.  Eur Urol. 2005;  47 403-408
• 15 De Jesus R, Dellon A L. Historic origin of the “Arcade of Struthers.”  J Hand Surg Am. 2003;  28 528-531