Surgery or not?

[gorenje]

I just got my report from the examinations (MRI, ultrasound and PSSD) conducted by Dr. Aszmann and Dr. Bodner. This is their conclusion:

"Both clinical examination and radiologic finding suggest the left pudendal nerve is affected at the dorsal canal due to chronic hypervascularity and venous congestion. The thick fascia in the UG diaphragm may be the remnant from the prostatitis that may have thickened with the recurrent infections."

The PSSD test also showed higher than normal levels on the left side (13 and 14 gm/mm2 as opposed to a normal value of less than 5). On palpation along the course of the pudendal nerve no trigger points were found. My main symptoms are weakened erection and weakened sensation. On a few occasions I have also had some pain in the perineum, but for the very most part I have no pain and no problems sitting. I can also sometimes feel a heat sensation in the perineum and in my legs. The treatment Dr. Aszmann can offer me would be bilateral decompression of the dorsal canal with resection of venous plexus. I have not made up my mind yet whether to have surgery and I am still looking for less invasive treatments, if possible.

I would appreciate any input/comment from anyone relating to this and also on possible alternative treatments that might be worth trying. Thank you.

[ezer]

gorenje, I also had abnormal PSSD numbers. I am not too sure what it means. All I can say is that the dorsal surgery was of no help. I have no recollection of people that have been helped by surgery when the diagnosis was venous congestion.

[gorenje]

LeilaRose and ezer, thank you for your reply.

LeilaRose's question: "Maybe you've discussed here many times (I didn't check) but what other conditions have been ruled out?"

The following conditions have been ruled out based on MRI and color doppler ultrasound conducted by Dr. Bodner: "No evidence of a slipping hernia in the inguinal area bilaterally. No enlarged lymphnodes in the inguinal area bilaterally... Normal appearance of the sacrum, especially at the level S2-S4, there is no evidence of a Tarlov cyst. Normal curvature of the sacrum and coccygeum. Normal volume and course of the piriforme muscle bilaterally. The pudendal fascicles show a normal course from the sacrum to the infrapiriforme foramen. The sacrotuberal and sacrospinal ligaments are unremarkable. The pudendal nerve show no swelling at the passage into the Alcock's canal on both sides. The obturator muscles demonstrate normal form and size. The urethral diaphragm shows minimal venous congestion. No evidence of pudendal nerve swelling at the pubic canal bilaterally."

[helenlegs 11]

I'm sorry gorenje, I don't have any answers for you unfortunately, having surgery or not, has got to be a personal decision. Pain, discomfort and accompanying symptoms are so subjective that it can't be anyone's call but your own.
Have you tried pelvic physiotherapy? There is a procedure for pelvic venous congestion alone without decompression surgery, sorry don't know a great deal about it, but from what people have reported here, it hasn't helped them tremendously.
Sorry I can't offer any more help.
Leilarose Hi again,
I don't fully accept your statement that PSSN tests are not reliable. I would say nothing can be concluded from that test alone BUT these results do help build a picture of the whole problem. The PSSN test by nature is to do with sensory cutaneous levels which may or may not be the issue. I would definitely register with this type of test however as I have absolutely NO feeling in many parts of my lower anatomy and reduced sensation in much of the rest although the fronts of my legs are fine. As some people may have a pudendal problem just or mainly affecting the motor functions of the nerve this PSSN test may not show anything completely accurately, but I don't think the findings should be discarded as useless. More that they are just one of the tools that may help clinicians arrive at a sensible diagnosis and therefore begin targeted treatments.
Take care,
Helen

[flyer28]

Gorenje, I am having somehow similar situation, MRI showed some "fibrotic thickening" in right dorsal canal.
dr.Aszmann proposed bilateral dorsal decompression. I did not have PSSD teest, I wrote him request to try it.
I have pain in the area of ischiocavernosus muslcle, bilaterally, right side worse.
On the other hand, I did not have any relief of pain after ultrasound guided dorsal nerve block, so this somehow question the PNE diagnose in my eyes.
I was struggling heavily with pain in the December/January, but lately I am having really better time, last 3-4 weeks, my pain decreased to 2/10 or so...
Having a very good PT in the city of Brno, Czech republic and still believe that PT with some lifestyle modifications might bring ultimate relief.
I was also diagnosed with CPPS/prostatitis, I think that my pudendal/dorsal nerve is surely irritated, but still think that there is not real entrapment.
Surgery is not a thing to be approached lightly, although dr.Aszmann is excellent surgeon.

[gorenje]

Yes, I think I will look into physical therapy as my first option.

[Jackson]

Hi,

At http://www.obgynnews.com there is a recent article by Dr. Hibner titled 'Pudendal Neuralgia' 04/06/12.

On page 3 under Diagnosis he says : "To date, there are no imaging studies that are reliable for diagnosis. Ongoing advances in MRI and MRN may make these modalities valuable in the future, but currently these techniques yield too many false negative results...pnmlt...sensory threshold."

I understand this to be Dr. Hibner's POV. Other PN specialists may have a different take on MRI/MRN etc.

Perhaps it's best to read the entire article to get the context in which his claim is made?

Cheers