Health Organization for Pudendal Education

If you already have scarring/scar tissue there, you may want to think about having the least invasive approach that is the least likely to cause more scar tissue to form. So that could be an advantage of the Dellon approach if he is careful to do a less invasive approach that would cause less scar tissue to form.

Violet

I got some more information from Dr. Dellon about this approach:

My symptoms are perineal/scrotal only. No issues with rectal branch or dorsal branch. The surgical approach that Dellon uses for these symptoms is an "anterior" approach in that an incision is made adjacent to the scrotum near the inner thigh. Only the perineal sensory branches are targeted. In my case he said he is not certain whether I have compression or a damaged nerve. So, if he were to operate, he could either look for scar tissue and decompress the nerve, or go further and resect the nerve and place end into the obturator internus muscle. It would be my choice based on comfort level. He said that with a decompression sometimes the nerve "wakes up" and causes more pain for a period of time because it is more sensitive.

Dellon's theory is that the TG approach fails many people because the issue is a bit further down the path of the nerve. He said a TG approach wouldn't work for me since my issue is further down. It makes sense to me, given that the only sustained relief I've gotten is from a nerve block with steroid injected into the Alcock's Canal. I'm pretty sure I'm not trapped up higher between the ST and SL ligaments like many of the stories I read on here.

This seems to be a pretty rare surgery, but makes most sense for my symptoms. Have any others on here done this approach with Dellon or something similar? Attached is a paper with more details.

Hi RC-

There are some old posters on this board who have either gotten the dorsal nerve surgery through the anterior approach, or at least discussed doing so extensively, either with Dr. Dellon or Dr. Aszmann in Europe. Try a search for PN_down_under, PelvisStressly, and flyer28. I believe that AliPasha also had the surgery, among various others.

I understand that decompression of the dorsal nerve is not the same thing as the resection of the perineal branches, but it uses the same (anterior) incision and would seem to be of the same general level of invasiveness. Just by looking at the pictures in the article that you posted, you can tell that this approach is far less invasive than the TG approach, and that the incision is fairly superficial (albeit in a very sensitive area).

Nevertheless, there are relatively few data points (a cohort study of 14 men is pretty tiny), and at least a couple negative stories on this board as to the dorsal nerve surgery. I wouldn't say that I have a "red light" feeling about this procedure, more like a "yellow light" that the jury is still out about its efficacy. Given the choice, I would also opt for decompression over resection, which seems like a drastic and permanent step, unless I were in dire and unrelenting pain.

I am considering a similar procedure, as I also have only anterior symptoms. I do have both perineal and dorsal nerve symptoms on the left, although the dorsal nerve symptoms are (thankfully) only sensory and "skin-deep"--altered sensation on part of the skin of the left side of the penis, exacerbated by sitting. There's nothing obvious or objective on my MRI though, except for a dilated varicose vein that Dr. Aszmann speculated might be impinging on the nerve anteriorly.

In the event that you do go through the surgery, I would be very interested to know about your recovery process and outcome.

I strongly suggest you go to google and type in “doctor Dellon review”. All the best.

Why does France or Hibner not do this kind of surgery that Dillon does?

Hi Ray,

It seems to me that the doctors you mention operate under the premise that the PN is entrapped and perform a surgery to remove the compression or adhesions to allow the nerve to move freely. I believe that Dr. Dellon with his resection procedure cuts the sensory branches and implants the remainder into muscle rather than identify a compression or if a compression is not present. In my time on PN forums and reading about PN, it seems both have mixed success.

Stephanies

In rereading some Dellon posts, it looks like Kathyd had resection of the PFCN with him years ago. If you search her posts, you can read what she wrote. I don’t think she had branches of the PN done.

Stephanies

Please be cautious. There is a reason the more experienced surgeons don’t do this because it’s not a decompression. It involves cutting the nerve. Had it done a year ago. The complications have been life threatening for me.

Okiegirl,

I am sorry your surgery was not successful and you have had complications from it. Thank you for the update.

Stephanies

Okiegirl, I am so upset to hear your surgery was not successful. It sounds like you have been through hell and my heart goes out to you.

Violet