Health Organization for Pudendal Education

I haven't seen much posted on this recently. Does anybody know of any doctors who use this technique? The only doctor I saw listed as using this treatment is Dr. Attaman in Seattle. I'm in the Baltimore area but would be willing to travel to give it a try.

RC

Quick update: I had an appointment with Dr. Howard Richard at the University of Maryland. He confirmed that he performs both pulsed radio frequency and cryoablation of the PN. He explained that his order of treatment is nerve blocks (diagnostic), then PRF, then cryoablation. He does not do neurostim devices or surgery and suggested that those are the most invasive and should be last on the list, which made sense to me.

He said if he gets even a decent result from PRF that he will repeat it to see if he can get it to stick. Then he moves on to cryoablation.

I had not seem him previously mentioned on the forums here. Has anybody had either of these interventions done with him?

RC

Did he explain fully what the risks would be?

Violet

Violet,

He suggested that the risks on the pulsed radiofrequency are minimal, and similar to a nerve block. It seems like there is a chance for a flare-up, but also some hope for some medium-term relief.

On cryoablation, I asked him specifically about the risks of causing issues with incontinence or sexual function in the dorsal or rectal branches. I only seem to have symptoms in the perineal branch, so I don't want to throw out the baby with the bathwater, so to speak. He said that since my pain is one-sided (left side), he would be more comfortable with trying it only at that side, so I would still have normal functioning on the right. He said he is very cautious about doing bi-lateral ablation because of those risks.

RC

I think the important thing is to understand what you are getting into. It's good that he explained it to you. It's probably not possible to just cryoablate the perineal nerve because it would be too small and too difficult to find but maybe that's a question you could ask.

Violet

Violet,

Yes, according to the Dr. Prologo interview on the front page as well as my conversation with Dr. Richard, it is difficult to just isolate the perineal branch. They say that they apply the treatment in the Alock's Canal. If I am understanding my anatomy correctly, that would mean that the treatment would affect a trunk of the nerve that ultimately innervates both the perineum/scrotum and penis. But, it might spare the rectal branch since that branch often separates before the entrance to the Canal. According to the Dr. Prologo interview they have had very few issues with incontinence (which would make sense if it misses the rectal branch). Perhaps the better question is what the treatment has done for sensation in the penis and sexual function. I will ask that of Dr. Richard in my follow-up.

RC

rc3432 wrote:Quick update: I had an appointment with Dr. Howard Richard at the University of Maryland. He confirmed that he performs both pulsed radio frequency and cryoablation of the PN.

RC, did he say how much these treatments cost? How difficult was it to get an appointment? I am interested in treatment from this same physician myself.

It looks like the PRF will be covered by my insurance. I'm with Aetna. I doubt they would cover a cyroablation but I'll check that if and when I consider it more seriously.

I was referred to Dr. Richard originally by Dr. Marvel for a nerve block. I don't know if he takes new patients directly, but its worth a try. The number is 667-214-1576.

I am trying the PRF on Monday November 5th. I will post updates back here.

Bob

Good luck with PRF, Bob.

Violet

Good luck tomorrow, Bob!

April