Pudendal Nerve Entrapment Within Alcock's Canal as a Compartment-Like Syndrome: A Systematic Review

Pudendal nerve entrapment (PNE) within Alcock's canal is an under-recognized cause of chronic pelvic and perineal pain, increasingly conceptualized as a compartment-like syndrome due to sustained neurovascular compression within a confined fascial space. This systematic review evaluates the anatomical, pathophysiological, diagnostic, and therapeutic evidence supporting this hypothesis. A comprehensive literature search was conducted across PubMed, Embase, Scopus, and the Cochrane Library from April 2026 to May 1, 2026, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ten studies were included in the final synthesis, comprising observational studies, cadaveric anatomical analyses, imaging-based diagnostic studies, and interventional and surgical outcome studies. Sample sizes ranged from a cadaveric series of 15-20 specimens to clinical cohorts exceeding 200 patients. Evidence consistently demonstrated that repetitive mechanical stress, fascial constriction, and impaired venous drainage within Alcock's canal may lead to ischemic neuropathy and progressive pudendal dysfunction. Diagnostic modalities such as magnetic resonance (MR) neurography, Nantes criteria, and nerve blocks improved clinical identification, while surgical decompression showed variable but often favorable outcomes. However, significant heterogeneity, small sample sizes, and a lack of standardized outcome measures limit definitive conclusions. Overall, current evidence supports a compartment-like pathophysiology, although further prospective validation is required.