Health Organization for Pudendal Education

hi, as posted earlier, I had varices impinging on pudendal nerves in alcocks canal as diagnosed by dr. Potter. Recently, saw dr Fan., interventional radiologist at brigham in boston, who did more complete vascular mri of pelvis. she was not impressed with enlarged veins in either mri and very doubtful they would be causing PN.!!!! she's experienced dr. who specializes in pelvic congestion syndrome, "Iv'e seen lots of veins"; so might want to consult with her or someone like her before proceeding with embolization procedures based on dr. Potter's mri, pdn

Thx PDN
for your input about varices and DR Fans opinion. She seems to agree with most of the docs that these veins aren't causal
My inteventional radiologist, thought the emboliaztion might help with my bladder pressure issue, but wasn't too sure about the sitting pain. I could tell that he had not seen a case where pelvic varices caused this PN pain. He is at Columbia in NYC.
Anyway since my May embolization didn't help I hesitate to do it again on the other side.

we also sent my MRIs to pelvic congestion doc at Johns Hopkins, almost a yr ago.He never even returned our calls.

The earlier post in this thread made sense in describing how the varices get intertwined with everything in that area,(PN and Alcocks canal). But I wonder does all this account for what those of us with varices are feeling?For me the pain increases as time goes by.

I will email Dr Potter, and tell her that we tried emobolizaton/without relief and see what and see what she says??
There seems to be many of us with these varices...

I wonder if ANYONE on our boards has experienced relief ater an embolizaton ...Pls post if you have or feel free to PM me.
Thanks everyone,
Kathy
Kathy


Hubby now wants me to consider getting the right side done, but I would hate to try yet anoter procedure unless I felt it would help. His other thougth was an exploratory in the pelvic to get a closer look,
I do have this Pelvic Congestion syndrome but aside from another emobization I just don't know what to do?
I may email Dr Potter and see what she thinks, explaining to her that my first embolization didn't

I

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sorry for typos...
i hit send too and didnt't notice them!

Varices Have Been A Confirmed Cause of Pudendal Compression.

Although it may or may be rarer than other causes, branches of the Pudendal
nerve have been confirmed to be compressed by Varices(enlarged veins) Dr.
Aszmann,(Austria) and Dr. Possover M.(Switzerland) have both confirmed this
from surgery. Dr. Aszmann has confirmed 2 cases of this occurrence to me
personally. Having said that it is best probably to let the nerve surgeons
handle the Varices in these areas so close to the nerves and I'm pretty sure that
Aszmann ligates and resects it if he finds it to be the problem. I'm not sure
how other nerve surgeons would handle the enlarged veins if they found it to be
the cause of compression, but it would probably be the same way. Dr. Dellon has
also said that if the Varices are the cause of the compression that he can also
take care of it during surgery.

I don't think that Aszmann or some other sugeons recommend doing sclerosing
of the vein as it may possibly cause more scare tissue, and it is probably best
to let them do the surgery in case Varices is not the cause of the compression
and the only way to really know for sure is by surgery that we know of so far,
since nobody has confirmed they have gotten better by getting the veins taken
care of by sclerosing or embolisation alone so far anyways.

Here is a sample of my conversation with Dr. Aszmann
Hi Dr. Aszmann, Have you ever operated on somebody with varices (pelvic
congestion) in the pelvis or dorsal branch of pudendal nerve in which case the
varices (enlarged veins) was the only cause of the compression of the dorsal
branch of the nerve or another nerve in the pelvis? I'm just curious. Thanks

Yes, a man and a woman. Both had the diagnosis “venous congestion in the
urogenital diaphragm” in their MRI report. Intraoperatively the woman had
varicous veins and a rather large pudendal artery bilaterally. The man had a
very bulbous ischiocavernous body on the affected side- the other being almost
normal. In men the space available is very tiny, since the canal of the dorsal
nerve is anatomically tight already. The woman had tried intravasal application
of a foam to obliterate the venous network- to no avail hoewever. I have
operated her just before the summer and she is fine so far. The man I have not
heard of after a 3 month follow-up phone call.
He also said he has seen enlarged blood vessels causing compression in other areas of the body in his email he sent to me . Here is the rest of his email There are many other nerve compressions caused by blood vessels in other body parts. Some of them even have a name. In the upper extremity the radial nerve can be compressed by prominent vessels- if so these vessels are then called “the leash of Henry” Also in the tarsal tunnel for the tibial nerve this is known cause of nerve entrapment.

Hope this helps everyone to know that there is another possible cause of
compression other than ligaments/tendons/scar tissue at leasst in the area of
the dorsal branch of the Pudendal Nerve.
He also said he has seen enlarged blood vessels causing compression in other areas of the body in his email he sent to me . Here is the rest of his email There are many other nerve compressions caused by blood vessels in other body parts. Some of them even have a name. In the upper extremity the radial nerve can be compressed by prominent vessels- if so these vessels are then called “the leash of Henry” Also in the tarsal tunnel for the tibial nerve this is known cause of nerve entrapment.

hi K athyd, please see my post recently under pelvic congestion and varices. Essentially, had very experienced radiologist at BWH in boston, dr. Fan, do her own pelvic mri and read dr. Potter's mri which pointed to varices impinging on pudendal nerves. she did not agree wih dr. Potter's reading at all. Would be careful of pursuing treatments based soley on dr.Potter's mri as is a relatively new procedure without alot of data yet, pdn

Had left side scrotal varice embolized today. Will post details and results next week.

Don

hi Kathyd,, also had mri from dr Potter which showed varices impinging on pudendal nerve in alcocks canal. Saw dr Fan, interventional rediologist at BWH in boston who specializes in pelvic congestion syndrome for many years, who sdid her own vascular pelvic mri. she did not see enlarged veins either on her mri or dr.Potter's mri. dr Potter's mri data are relatively new,so I would be careful about pursuing treatments based solely on her mri findings, pdn

Dr. Potter saw enlarged clitoral vein on the right side that could possibly being causing problems but also have scarring of bilateral clitoral pudendal branch. Dr. Hibner did an ultrasound of both clitoral veins when he did my dorsal pudendal nerve block and he said both sides were within normal range about 2mm and did not see any enlargement. I still highly recommend Dr. Potter's MRI but need to confirm things before moving forward based on only the MRI. Many things to still work out and understand about the MRI.

donstore wrote:Had left side scrotal varice embolized today. Will post details and results next week.

Don

Hope you're feeling better, Don! Looking forward to your post.

This was in the report Dr Aszmann gave me after surgery

"The left pudendal nerve had a significant pseudoneuroma with some internal scarring. Both the roof of the canal was very fibrotic and there was marked varicositas vessels alongside the nerve."

I asked about these 'varicositas thingys', and he explained that it was a result of the compression injury, not the cause. I imagine that the veins would have to be VERY big to cause the compression themselves. The pudendal nerve is not microscopic.