Health Organization for Pudendal Education

Just wondering if there are any Dr. Aszmann Success Stories Out There? I know that A's Mommy recently had surgery with Aszmann, and is still on the road to recovery now, but was wondering if anybody else has had success with Aszmann in the past? Since he is in Austria, I realize there may not be a lot of people who reply to this post, but just thought I would see if anybody has had success on this site with him.

I have an appointment with him at 21st December.
My 3T MRI revealed some varix in Alcock, lately my pain shifted a little bit toward the location of right Alcock.
Still struggling with the pain, altough pain is under control (3-4/10)
I could ask dr. Aszmann what are the outcomes from the recent surgeries performed by him.
Matt

Yesterday I had the apointment with dr. Aszmann, here are the conclusions:

He palpated all the course of pudendal and dorsal and found no painful spots. especially the Alcock is out of question, no Tinnel sign, no sitting pain. That means, that if the dorsal is involved, it must be somewhere more distally. That means, that there is no sense in infiltration of Alcock (or higher), because it might irritate the nerve and the problem is obviously not there. Though, there might be some entrapment of dorsal somewhere in penile ligament. He promised to analyse my 3T MRi and make in january 17MhZ ultrasoound with prof. Bodner. After that we might try dorsal nerve block, which is far more safer than classical pudendal block.

If the dorsal nerve block fails, that means that the pain is transmitted sympatethically, through cavernous nerves. Those nerves might be in cramps, imposed by mild injury/pelvic tension (mainly ischiocavernosus and bulbocavernosus). If the physiacl therapy fails, there is an option of some sympathetic blocks, preferably the block on superior hypogastric plexus (the block is quite safe with comparison to infiltration of Alcock).

Regarding his operations outcomes: he said that basically I am not the optimal candidate for operation, but analysis of MRI and 17Mhz ultrasound plus dorsal block might change it. Till this time, he never made anybody worse, there were patients benefiting from operation hugely, there were patients benefiting slightly and there were patients with zero benefit (but no new pains).

He was very friendly and cooperative.

Hi Flyer28,
Thanks for letting us know how everything went and keep us updated.

Finally I have evaluation of my 3T MRI from prof. Aszmann:

Here it is:

"Sorry for the tardy reply. I have been out of town a lot during January. I have looked at your MRI with Prof. Bodner 10 days ago. There are a few things that we saw:
1.) you have additional muscle bellies of the glutaeus maximus at the posterior aspect. These however, do not impinge the nerve, even though they come close to the nerve.
2.) the course in Alcock’s canal is unsuspicious and does not show any problems.
3.) on the right distal canal, where the dorsal nerve of the penis is located at the urogenital diaphragm there is some fascial thickening, as if you had a trauma there.

The last finding we can address surgically. So please let me know how to fare.

OC Aszmann"

My comment: I always knew that my problem is not in Alcock or higher, this is a good news. I feel that prof. Aszmann is right that the problem is somewhere in the course of Dorsal nerve. This trauma is probably the impact of extracorporeal shocking wave, which aggravated my pain (however I had milder pain before), the dorsal was irritated thats for sure.
On the other hand, I dont know whether this is clear cut case for operation or is it some borderline case with unclear perspective. The operation cannot be approached lightly. I would ask those of you, who had problem with dorsal, what do you think? Was your case similar?
many thanks
flyer28




------------------------------------

flyer28 wrote:1.) you have additional muscle bellies of the glutaeus maximus at the posterior aspect. These however, do not impinge the nerve, even though they come close to the nerve.

Hi Flyer,
This statement caught my attention. Have you been diagnosed or treated for piriformis syndrome? Do you have any sciatic pain?
I'm sorry you didn't benefit from the shockwave therapy and wish you the very best with making a decision about how next to procede.
Best regards,
Karyn

flyer28 wrote: This trauma is probably the impact of extracorporeal shocking wave, which aggravated my pain (however I had milder pain before), the dorsal was irritated thats for sure.

Sorry I can't answer any of your questions, but i am intrigued by this statement. Where did you have Shockwave therapy at (as in what state/country)? I know the decision to have surgery or not is very difficult. I am in that boat right now.

Flyer,

I'm curious about your shockwave treatment too. As I posted elsewhere, I'm very sorry that it worsened your pain.

I had extracorporeal shock wave (ESW) EXACTLY one year ago, 1.2. 2011 here in Bratislava, Slovakia, Europe.
Performed by my orthopedist who attributed my pain in pubic, inguinal and genital region to strained inguinal ligament.
My pain was always worse after some physical impact - playing tennis, sex, physical labour.
I had only one session and that day my pain radically worsened for 3-4 months, before it came back to baseline.
I was very much profiting from blind corticosteroid shots in pubic region, the pain came dow to lets say 2 from 10 on Visual analogue scale.
I regret very much that ESW experiment and 2 or 3 urologist told me that they would never allow to apply it on the pubic/inguinal region.
It is very effective to break calcifications in elbow or feet, but to apply it in pubic region is "pure hazard" (I regret that I did
not consult that step with my 2 urologists, it was a little bit "blind shot" from me, but I was assured that procedure is
completely safe, which is obviously not true.
I know that many of you have different experience with ESW, but my opinion is NEVER EVER AGAIN.

I guess that my dorsal nerve was irritated before, but the pain was mild and bearable.
This ESW probably imposed direct trauma in the osteofibrotic dorsal canal ("sulcus dorsalis nervi penis")
where is now the underlying problem.
I still believe that this condition is manageble with nerve blocks and PT, if it fails I will
probably have no other option than decompression made by dr. Asmann.
My only luck in this hell situation is that I am living only 1 hour driving distance from dr. Aszmann.
This is how I feel it now.

flyer28 wrote: I guess that my dorsal nerve was irritated before, but the pain was mild and bearable.
This ESW probably imposed direct trauma in the osteofibrotic dorsal canal ("sulcus dorsalis nervi penis")
where is now the underlying problem.
I still believe that this condition is manageble with nerve blocks and PT, if it fails I will
probably have no other option than decompression made by dr. Asmann.
My only luck in this hell situation is that I am living only 1 hour driving distance from dr. Aszmann.
This is how I feel it now.

Thanks for sharing your experience with ESW. So sorry for your increased pain! I am considering ESW, but am truly scared of the inflicted trauma that might occur. I have gotten worse from pretty much every invasive treatment I have tried and I think part of that is due to my Central nervous system sensitization and the trauma from the treatments. That is what concerns me about ESW, while it is not invasive it can still be traumatic to the body. Trauma to my SI joint/ligaments is what set off this pain and I don't know that inflicting more trauma will help.

What a blessing you live only an hour from Dr. Aszmann. I hope you find relief soon. Keep us posted!