Health Organization for Pudendal Education

Hello PNE'ers and other pelvic nerve sufferers,

There is a new chapter on pelvic pain written by Dr. Dellon and it is now up on his website. It is chapter 12 of his book, titled "Pain Solutions"

I'm so glad I checked today because I knew it was "in the works" and I didn't know how long it would be before he published it. It is full of illustrations and photos, which I found very helpful, plus it is written in a way that is easy to understand.

Here is a direct link to the book, titled "Pain Solutions"
http://www.dellon.com/content/view/116/307/

Or you can go to Dr. Dellon's website - http://www.dellon.com
Click on the link for his book, called "Pain Solutions"
Click on Volume 12 and the chapter will open

(By the way, Volume 1 is really good for an overall understanding of what can go wrong with nerves, such as neuromas.) I wish I had this information before I started having any pelvic procedures. I would have saved myself some painful lessons, and I would have known the right questions to ask!

p.s. Also, the entire book is free, and can be downloaded to your computer to print, or you can just read it onscreen.

Thanks for the info. The chapter is a wealth of information. Just wish he took insurance! I would be in the poor house if I did all the surgeries he thinks I need. Plus, not sure I agree with everything he recommended but that is a another story for another thread and day. Thanks again.

Thanks for this lottanerve, very interesting reading. I especially liked the SUMMARY in particular the last sentence.

SUMMARY
Chronic pelvic pain can be treated non-operatively, successfully in most patients
with pelvic floor physiotherapy, medication, and treatment of associated problems,
such as interstitial cystitis, endometriosis, bowel problems and depression. When
these approaches fail, and especially with a history of trauma, the symptoms may be
related to entrapment of the pudendal nerve somewhere along its winding, and
variable anatomic passage from within the pelvis, near the sacrum, to the ischiorectal
fossa, to the pubic ramus, and finally to the penis/clitoris. To determine the location
of the entrapment, the history of the trauma/symptoms, physical findings, and the
results of nerve blocks are critical. Based upon these determinations, a decision can be
made as to the optimum surgical approach for a neurolysis of the pudendal nerve. In
some people, more than one surgical approach may be necessary, one from the front,
at the pubic ramus, and one from the back, transgluteal (ischiorectal), requiring two
different surgeries. There should be hope for relief in 80% of people.

helenlegs 11 wrote: There should be hope for relief in 80% of people.

Sounds good! But IS there?!?!!

Thanks, LottaNerve,

I have been wondering why I have all these symptoms that no one else seems to have, like decreased sensation from the top of the gluteal fold to the back of the knee. It's because I most likely have entrapment of the FCN! I learned so much from reading that chapter. Now I don't know whether go ahead with my scheduled PN surgery.

LottaNerve, how are you since your pudendal surgery with Dr. Dellon? Are you still seeing improvements? Has it been slower going than what you hoped? Is there more surgery in your future because there might be another trapped nerve? Wishing all the best!

Forgot, I don't know where he gets the 80% improvement from? He told me he anticipated 80% improvement on the nerves he recommended I needed surgery on. He has no published statistics on the pudendal nerve. I think he might be using some of his numbers from his other nerve surgeries anticipating the same results.

What fascinating reading, it is like a detective story, putting all the clues together. Thankyou so much Lottanerve. I think everyone with PN issues should read this, it is very illuminating.

Actually nyt on page 35 he seems to be giving himself 100% success rate and is comparing himself with many other surgeons on this list, I think all fall below his success rate.
He may well be right because he has done 'the detective work' and so is using his pubic ramus/litotomy position procedure (5 patients) with compression after the exit to Alcocks canal which has, only recently(ish), been known as a site of entrapment ? ? (was he the first to develop this?)
Of course many of the surgeons may never get 100% success rate because some of the patients entrapment would never be accessible through a TG approach, which is all they offer.
The dates of some of the other surgeons figures are from way back when I'm not sure that anyone was considering that entrapment could occur in the lower (post Alcocks) pudendal, and branches path. I wonder though how many vertical/buttock ss/st ligament and entrance to Alcocks he has done and not got on this list.
It seems a little naughty to use this small very recent sample of patients,a but I could have got my reasoning wrong (what do I know) maybe they are the only published results to compare. So don't try and compare? ? Please correct me if I am way off the mark with this.
I do think apart from that everything he has written just gives us all more valuable information which is fantastic.

We have to be careful how Dr. Dellon defines 100% success rate. That does NOT mean cure. If you said you had 90% improvement you would fall into the category of success or if you had 10% improvement you would fall into the category of success. In one of his publications he has divided up how he classifies his success rates so we must be careful that this does NOT equal cure.

I really like Dr. Dellon but he did not give the other side of the story to the ST ligament. He never mentions the publications by Vleeming that show the ST ligament is important for stability. What I wish he would have done is stated the literature is mixed but from his reading and conversations with leading ortho dr.'s he has come to the conclusion the ST ligament is not important. I was bothered by the idea that he didn't mention the papers that show the other side of the story.

I don't know that much about the Neurowrap but from what I understand it can adhere to other structures but is not suppose to adhere to the nerve. However, his pictures are quite convincing.