Pudendal Nerve Neurolysis
Pudendal Nerve Neurolysis
On Monday, May 16, I saw Dr. Hanson at the Centeno-Schultz clinic. He performed a pudendal nerve hydrodissection. or neurolysis. He injected saline and cortisone along the pathway of the pudendal nerve, starting at the ishial spine. He also injected the obturator internus and hydrolyzed some scar tissue at the sciatic nerve. He was able to view the nerves by use of a MSK ultrasound. The theory is that injecting the fluid pushes the tissue away from the nerve, allowing it time to shrink and heal. For the first time I had 90% pain relief, although I still had numbness in the rt. saddle area. I continue to have almost complete relief of buttock pain, although I still cannot sit. But that is reasonable, as the nerve needs to heal, just as in decompression surgery. I intend to go back and have more work done on the rt. side as well as the left. I would recommend this procedure to anyone having PN pain before resorting to surgery.
- helenlegs 11
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Re: Pudendal Nerve Neurolysis
Hi Paulette,
That sounds fantastic. . . . I am so pleased it has helped you so much. It's not something I have heard about before, hopefully it will be something a lot of us will be able to take advantage of in the future. Thanks for the post.
(((hugs))) from Helen
That sounds fantastic. . . . I am so pleased it has helped you so much. It's not something I have heard about before, hopefully it will be something a lot of us will be able to take advantage of in the future. Thanks for the post.
(((hugs))) from Helen
Fall 2008. Misdiagnosed with lumber spine problem. MRN June 2010 indicated pudendal entrapment at Alcocks canal. Diagnosed with complex variant piriformis syndrome with sciatic, pudendal and gluteal entrapment's by Dr Filler 2010.Guided piriformis botox injection 2011 Bristol. 2013, Nerve conduction test positive; new spinal MRI scan negative, so diagnosed for the 4th time with pelvic nerve entrapment, now recognised as Sciatic, pudendal, PFCN and cluneal nerves at piriformis level.
Re: Pudendal Nerve Neurolysis
Oh, Paulette!!!! I'm sooooooooo very happy for you! How exciting!
Are you on a schedule for treatments? I know you mentioned going back again, but was wondering how many treatments you'd have to undergo to acheive a lasting effect? Are the treatments themselves painful?
You've just made my day, Paulette! Thanks for sharing the info and please keep us posted about your progress!
Love and hugs,
Karyn
![Very Happy :D](./images/smilies/icon_e_biggrin.gif)
Are you on a schedule for treatments? I know you mentioned going back again, but was wondering how many treatments you'd have to undergo to acheive a lasting effect? Are the treatments themselves painful?
You've just made my day, Paulette! Thanks for sharing the info and please keep us posted about your progress!
Love and hugs,
Karyn
Ultra Sound in 03/08 showed severely retroverted, detaching uterus with mulitple fibroids and ovarian cysts.
Pressure and pain in lower abdomen and groin area was unspeakable and devastating.
Total lap hysterectomy in 06/08, but damage was already done.
EMG testing in NH in 04/10 - bilateral PN and Ilioinguals
3T MRI at HSS, NY in 09/10
Bilateral TG surgery with Dr. Conway on 03/29/11. Bilat ilioinguinal & iliohypogastric neurectomy 03/12. TCD surgery 04/14.
Pressure and pain in lower abdomen and groin area was unspeakable and devastating.
Total lap hysterectomy in 06/08, but damage was already done.
EMG testing in NH in 04/10 - bilateral PN and Ilioinguals
3T MRI at HSS, NY in 09/10
Bilateral TG surgery with Dr. Conway on 03/29/11. Bilat ilioinguinal & iliohypogastric neurectomy 03/12. TCD surgery 04/14.
Re: Pudendal Nerve Neurolysis
This is just wonderful! I am so glad that you are that much improved and I certainly hope that you have lasting effects from this treatment.
How small of an incision does he make? How much water pressure does he have to use or dose he just insert a needle and forcefully push fluid into the area? I'm trying to figure out how different this would be from a nerve block other than he used saline instead of marcaine.
Keep us posted on how you are doing. If this ends of working just as good surgery this could be a big breakthrough.
How small of an incision does he make? How much water pressure does he have to use or dose he just insert a needle and forcefully push fluid into the area? I'm trying to figure out how different this would be from a nerve block other than he used saline instead of marcaine.
Keep us posted on how you are doing. If this ends of working just as good surgery this could be a big breakthrough.
2/07 LAVH and TOT 7/07 TOT right side removed 9/07 IL, IH and GN neuropathy 11/07 PN - Dr. Howard
6/08 Obturator neuralgia - Dr. Conway 11/08 Disability, piriformis syndrome - Dr. Howard
4/09 Bilateral obturator decompression surgery, BLL RSD - Dr. Howard
9/10 Removed left side TOT, botox, re-evaluate obturator nerve - Dr. Hibner
2/11 LFCN and saphenous neuralgia - Dr. Dellon 2/11 MRI with Dr. Potter - confirmed entrapment
5/11 Right side TG - Dr. Hibner 2012 Left side TG - Dr. Hibner
6/08 Obturator neuralgia - Dr. Conway 11/08 Disability, piriformis syndrome - Dr. Howard
4/09 Bilateral obturator decompression surgery, BLL RSD - Dr. Howard
9/10 Removed left side TOT, botox, re-evaluate obturator nerve - Dr. Hibner
2/11 LFCN and saphenous neuralgia - Dr. Dellon 2/11 MRI with Dr. Potter - confirmed entrapment
5/11 Right side TG - Dr. Hibner 2012 Left side TG - Dr. Hibner
Re: Pudendal Nerve Neurolysis
Dr. Henson used saline and marcaine. It did not involve an incision, only a needle stick, only a lot more fluid is involved, which he injects with a syringe. He said I can come back for a second treatment, including the left side. He said if that doesn't heal me, he will use human growth factors, which poses a problem for me, because my insurance would not cover it. He said human growth factors heal the nerve. I know some physicians use Sarapin. I am going to try to talk him into using that drug. I have read up on it, and it doesn't seem to have any adverse effects and also promotes nerve healing. Yesterday I saw a PT who encouraged me to do some gentle ham strings and piriformis stretches. That was the wrong thing to do, as it inflamed the nerve and caused some of the buttock pain to return. But i am still hoping the pain will calm down.
I am also in touch with Dr. Hal Martin from Oklahoma City, who does pudendal decompression surgeries endoscopically. There is another surgeon in LA by the name of Nader Pouratian. He is a neurosurgeon who does pudendal decompression surgery, sometimes endoscopically, sometimes open surgery. It is exciting to see that there are more surgeons who are aware of this problem than we may have originally realized.
I hope I have answered everyone's questions.
I am also in touch with Dr. Hal Martin from Oklahoma City, who does pudendal decompression surgeries endoscopically. There is another surgeon in LA by the name of Nader Pouratian. He is a neurosurgeon who does pudendal decompression surgery, sometimes endoscopically, sometimes open surgery. It is exciting to see that there are more surgeons who are aware of this problem than we may have originally realized.
I hope I have answered everyone's questions.
Re: Pudendal Nerve Neurolysis
Paulette, so glad to hear you are feeling better. I would be interested to hear more about the approaches used by the two docs you mentioned -- Dr. Martin and Dr. Pouratian.
http://www.drhalmartin.com/pages/drmartin.htm
http://www.uclahealth.org/body.cfm?id=4 ... &ref=95328
You stated they perform surgery endoscopically -- do you know what is the point of entry for the surgery? Dr. Bautrant also uses an endoscope when performing the TIR approach.
I'm sure there are other physicians we don't know about who treat PNE and we always appreciate it when patients come back and relay their experiences to other forum members. How were you able to find out about these physicians?
http://www.drhalmartin.com/pages/drmartin.htm
http://www.uclahealth.org/body.cfm?id=4 ... &ref=95328
You stated they perform surgery endoscopically -- do you know what is the point of entry for the surgery? Dr. Bautrant also uses an endoscope when performing the TIR approach.
I'm sure there are other physicians we don't know about who treat PNE and we always appreciate it when patients come back and relay their experiences to other forum members. How were you able to find out about these physicians?
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
Re: Pudendal Nerve Neurolysis
Hi Paulette,
Great to hear you have found some relief. Please keep us posted on this new therapy. Also, any additonal info on the new docs. I know you were considering a 1.5T MRI with Dr. Potter due to the metal in your back. I will be seeing her on next Wednesday for the same due to the metal in my hip.
Best Wishes,
Don
Great to hear you have found some relief. Please keep us posted on this new therapy. Also, any additonal info on the new docs. I know you were considering a 1.5T MRI with Dr. Potter due to the metal in your back. I will be seeing her on next Wednesday for the same due to the metal in my hip.
Best Wishes,
Don
Mild to moderate PN for 5 plus years, pain controlled by lyrica and opiates.
Nerve block (unguided) 9/10 Dr. Jerome Weiss - sciatica for 5 months but got numb in painful perineal/scrotal area - he diagnosed entrapment - but no more cortisone for me
Potter MRI 5/11 - rt STL entrapment of PN at Alcocks
Consult with Dr. Hibner Feb. 2012
Bilateral inguinal hernias diagnosed by dynamic ultrasound - surgery on 6/20/13
Feeling a little better, a few more months will tell
Nerve block (unguided) 9/10 Dr. Jerome Weiss - sciatica for 5 months but got numb in painful perineal/scrotal area - he diagnosed entrapment - but no more cortisone for me
Potter MRI 5/11 - rt STL entrapment of PN at Alcocks
Consult with Dr. Hibner Feb. 2012
Bilateral inguinal hernias diagnosed by dynamic ultrasound - surgery on 6/20/13
Feeling a little better, a few more months will tell
Re: Pudendal Nerve Neurolysis
Hi, Violet,
I do not know the point of entry for Dr. Martin's endoscopic surgery. I will probably fly to Oklahoma City for an exam. It is comparatively close to my home and cheap to fly there. His nurse said Dr. Martin checks all around the pelvis to find all possible sites of entrapment. I assumed she meant he explores with the endoscope, but i can't say that for sure. I did ask her if he cuts the SS ligament. She said he does not feel that is beneficial. In my case, I believe it would be. My pudendal nerve pain is worse since having my SI joint fused. I have come to realize the reason for the development of my PN pain is because my spine surgeon did not fuse my pelvis in a neutral position. He gave me an extreme lordosis, which has caused my muscles and ligaments to be pulled up and tight, compressing the pudendal nerve. Dr. Hanson said he could tell my nerve is not adhered to the sacrotuberous ligament. But he only treated 2 cm., so I imagine it could be entrapped elsewhere or at the OI, which is what Dr. Martin believes.
Dr. Pouratian required that I send him my records before even agreeing to see me. His nurse said after he sees me and determines whether I need decompression surgery, then we will discuss whether to use an open approach or endoscope approach. Again, I am hoping he is open to cutting the SS ligament. I have had piriformis injections, and I don't believe releasing the piriformis will benefit me. Hope this helps.
I do not know the point of entry for Dr. Martin's endoscopic surgery. I will probably fly to Oklahoma City for an exam. It is comparatively close to my home and cheap to fly there. His nurse said Dr. Martin checks all around the pelvis to find all possible sites of entrapment. I assumed she meant he explores with the endoscope, but i can't say that for sure. I did ask her if he cuts the SS ligament. She said he does not feel that is beneficial. In my case, I believe it would be. My pudendal nerve pain is worse since having my SI joint fused. I have come to realize the reason for the development of my PN pain is because my spine surgeon did not fuse my pelvis in a neutral position. He gave me an extreme lordosis, which has caused my muscles and ligaments to be pulled up and tight, compressing the pudendal nerve. Dr. Hanson said he could tell my nerve is not adhered to the sacrotuberous ligament. But he only treated 2 cm., so I imagine it could be entrapped elsewhere or at the OI, which is what Dr. Martin believes.
Dr. Pouratian required that I send him my records before even agreeing to see me. His nurse said after he sees me and determines whether I need decompression surgery, then we will discuss whether to use an open approach or endoscope approach. Again, I am hoping he is open to cutting the SS ligament. I have had piriformis injections, and I don't believe releasing the piriformis will benefit me. Hope this helps.
Re: Pudendal Nerve Neurolysis
Hi, Don,
I was going to have a 3T MRI by Dr. Potter, but then I heard about Dr. Hal Martin and his ability to read the 3T MRI. I know of a woman who had a 3T MRI by Dr. Potter. When she read it, she missed an entrapment at the OI that Dr. Martin found. So I sent my 3t MRI that was done in Colorado to Dr. Martin in Oklahoma City. Dr. Pouratian at UCLA uses the MRN.
After the pudendal nerve neurolysis on Monday, I felt wonderful. As I stated above, I tried some stretches, which inflamed the nerve. I regret to report that much of the pain has returned but not all of it. I would like to try the procedure again, especially on the left side. I think my true problem is the fusion of my spine to the pelvis and an improper alignment of the pelvis. I don't even know if a pudendal nerve decompression surgery would resolve the problem. I need more room in my pelvis. If anyone has any ideas, I would love to hear them.
Violet, you asked me how I heard about the two surgeons I mentioned. I heard about them from a couple of women on the yahoo piriformiss forum.
I was going to have a 3T MRI by Dr. Potter, but then I heard about Dr. Hal Martin and his ability to read the 3T MRI. I know of a woman who had a 3T MRI by Dr. Potter. When she read it, she missed an entrapment at the OI that Dr. Martin found. So I sent my 3t MRI that was done in Colorado to Dr. Martin in Oklahoma City. Dr. Pouratian at UCLA uses the MRN.
After the pudendal nerve neurolysis on Monday, I felt wonderful. As I stated above, I tried some stretches, which inflamed the nerve. I regret to report that much of the pain has returned but not all of it. I would like to try the procedure again, especially on the left side. I think my true problem is the fusion of my spine to the pelvis and an improper alignment of the pelvis. I don't even know if a pudendal nerve decompression surgery would resolve the problem. I need more room in my pelvis. If anyone has any ideas, I would love to hear them.
Violet, you asked me how I heard about the two surgeons I mentioned. I heard about them from a couple of women on the yahoo piriformiss forum.
Re: Pudendal Nerve Neurolysis
Thanks, Paulette -- what would we do without forums!?!?!?!
I'm sorry to hear your pain is back but it's possible having the procedure done may have helped to confirm that you have a nerve impingement somewhere along the pathway where he injected or distal to that, and that it's not a problem with the spinal/sacral area.
I'm sorry to hear your pain is back but it's possible having the procedure done may have helped to confirm that you have a nerve impingement somewhere along the pathway where he injected or distal to that, and that it's not a problem with the spinal/sacral area.
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.