Health Organization for Pudendal Education

I tried to talk to my doctor about ordering a Potter MRI and he keeps telling me it's not going to help. I am supposed to go to Houston for an evaluation and they basically said it wouldn't matter either. Since I've already had a regular MRI locally I wonder if insurance would cover the Potter MRI and is it accurate enough to really make a difference. Most of what I read here is all positive about the 3T MRI but I also remember reading somewhere that Dr. Hibner is now starting to doubt them. This is all pretty confusing and was wondering if the experiences match up with the claims about the MRI being worth the expense and the wait.

I don't think that Dr Hibner is doubting the imaging reports that Dr Potter produces, more that it is still in it's infancy.
He has actually found when operating, that some patients have exactly the pathologies described in those reports.

I think that a good, knowledgeable clinical diagnosis is THE most important influence on a diagnosis however (with a huge emphasis on knowledgeable)
Although sometimes imaging may back those clinical findings up, the actual scan on it's own can't be used singularly as a diagnostic tool . . . . . yet?? (I still believe that it will need a man who can for some time, or woman obviously )
The scan may be valuable determining where a patient may have a PN compression/entrapment. Which is helpful 'geographically' so that any surgical procedure can to be accessible from a particular incision point.
I know that Dr Hibner has his own methods to determine if the compression is say at ss/st ligament level/Alcocks canal or dorsal for instance, therefore the scan isn't an absolute necessity.
In some cases, I would worry that this (expensive) imaging may show nothing and then a person could be back to square one (back to being disbelieved for instance)
However,I very much doubt that a negative scan would hinder any clinical evaluation from him (it may with some clinicians ~shrugs~) and of course a positive scan may help.
It does seem tho' that he see's his clinical examination along side a person's history as the most evidential criteria for an accurate diagnosis.
I doubt that I've helped you make up your mind, sorry.
Take care,
Helen

I just wish there was a Potter MRI done in a group of people without pain,then Potter would make more sense to me,i don't know it is just my own thought.
Once in the OR ,of course the dr will find scar tissue etc,we are humans beings,but who knows,after all drs are humas beings too and they have to validate their surgical procedure for insurance purposes and own reputation.Or why don't they make more studies? like cutting a cadaver? of a person that of course never complained of pain down there, just wondering..


Lola2

I think that when a surgeon finds scar tissue, as you say,' who won't have some', and the nerve doesn't look healthy and pink or is squashed or adhered to something, that will show the need for decompression, although not necessarily ONLY at that point perhaps. Also if the nerve is unhealthy looking and white once the decompression is complete it should hopefully 'pink up' a little. This is just what I have read from surgical reports on this forum btw, not medical.
However I totally take your point about the justification for surgeries, insurance and professional esteem Lola. How cynical are we

Maybe you could take spinal studies into account too however. Imaging is fairly well proven in this case as the bony structures, misalignments and disc problems etc are more visibly reliable. Studies have still shown that some people, who may have a few issues showing on a scan actually suffer no pain.
I would think that say a large disc hearniation would always be painful but other slightly lesser problems may cause one person pain and another none. Maybe that is due to one small change not visible on a scan at the moment or a persons pain perception. Pain is so subjective I would doubt there will ever be an answer to that one.
That is why the knowledgeable clinical exam with a trusted and respected surgeon (just added that bit ) is all important. Yes the scan can back up a diagnosis, but that is about it. The other problem to run along side this is that the pelvis is so complicated and interconnected and the only real test as to what the problem is and then the answer to that problem is on the operating table and later hopeful recovery.
Did you know that the pelvic area was always thought to be the reason for nerve pain until imaging (probably x ray) could actually show the spine and any problems there. Once Dr's had that visible reference, the pelvis was discarded as a potential source of any nerve pain. Seems like we have almost nothing to thank imaging for, I just hope that it improves to the extent needed.
take care,
Helen