Anatomical Variations and Morphometry of the Pudendal Nerve: A Systematic Review and Meta-Analysis

The aim of this meta-analysis was to comprehensively review the available literature and determine the pooled prevalence of the morphometric and topographical characteristics of the pudendal nerve (PN), providing a better understanding of its anatomical variations and, consequently, enhancing patient safety during pelvic procedures.

A comprehensive search was performed across various major databases including PubMed, Embase, Scopus and Web of Science to find all articles regarding the morphology and anatomy of the PN. A total of 29 studies were included in this meta-analysis.

The most common type of PN trunk was a single trunk with 61.27% (95% CI 48.02-73.74%) prevalence, followed by double PN trunk with 27.94% (95% CI 17.74-39.41%). The mean diameter of the PN in the cadaveric studies was 3.73 mm (SE 0.33). The mean length of the PN in the cadaveric studies was 56.08 mm (SE 0.82).

This meta-analysis highlights the substantial anatomical variability of the pudendal nerve, which limits the feasibility of a single, universally applicable classification system. A comprehensive understanding of its morphology and branching patterns is essential for improving the safety and effectiveness of surgical and anesthetic procedures in the pelvic region. The findings emphasize the need for standardized methodologies and nomenclature in future anatomical studies to enhance comparability and clinical applicability. Ultimately, improved anatomical knowledge of the pudendal nerve may contribute to better diagnostic accuracy and reduced risk of iatrogenic injury.