Does Struan Coleman at HSS have a different surgical approach specifically for pelvic pain?

[sbbjjjjee]

Hi all,

I'm considering surgery with Dr. Coleman. As many have mentioned, he's confident in his statistics solving the FAI & labral tears is likely to help and even resolve the pelvic pain. Said 5% of his surgical patients have pelvic pain, and of those 80% have a complete resolution of their symptoms (higher likelihood of success in men than in women he said). He's an outlier though, and I've even talked to colleagues of his at HSS that aren't believers. I don't believe he's published research on this.

I'm considering surgery with Dr. Coleman or one of his colleagues. My question is: Does Dr. Coleman do anything differently in surgery that would make it specific towards patents with pelvic pain (repairing pelvic floor muscles perhaps?). I asked another doctor this, and he said it's a hip scope like any other.

I'm considering whether to go with Dr. Coleman who is out of network or one of his collegues. It would be great to go with Coleman given he is confident it will work, but if surgically he is doing the same things as other doctors, I may want to save the 20k (even if it's with a colleague who doesn't think it will work for pelvic pain). Thank you

[Violet M]

Sorry, I don't know the answer to your question, but I was wondering if you could ask Dr. Coleman if his procedure is the same as someone who is in your insurance network before spending the 20K. Do you have FAI and labral tear?

Violet

[sbbjjjjee]

Hey there, I do have FAI and Labral tears. I'm considering going with Dr. Nawabi at HSS who is also a top surgeon from my understanding. I'm going to try to ask Dr. Coleman that question before I have surgery with Dr. Nawabi. I've had 3 appointments with Dr. Coleman, so trying to do a 4th just to ask this question. Appreciate the response

[Violet M]

Good luck. Hope to hear some good news from you eventually.

Violet

[winged_cent]

Hi there:

I had hip arthroscopy with Dr. Coleman (he was in-network with my insurance at the time). Unfortunately, he does not have any special or magical technique relating to pelvic pain; it's just a regular hip scope. He may have some technique to make it less likely to cause pudendal-related side effects and is generally a good surgeon (I recovered quickly from the procedure and had no aggravation of anything). Unfortunately, it had no effect on my pelvic pain or pudendal symptoms.

[Violet M]

Awww...sorry to hear it didn't work for you. Have you decided on your next step?

Violet

[winged_cent]

Violet, at this point, I am pretty sure that I have tried everything short of surgery, and I now have had this problem for over 10 years. So I think the options are (1) do nothing; or (2) get surgery.

What is stopping me from getting surgery is that my symptoms are… not THAT bad, certainly compared to the stories of some of the folks on this board. I do have constant pelvic pain and tingling sensations in the distribution of the left pudendal nerve, but the pain is not sharp and usually tolerable, and I can still sit with a cushion or use a standing desk during the work day, and otherwise live a mostly normal life.

There are also several other factors that make it seem like it might be pudendal nerve irritation but not entrapment. When doctors internally palpate what they say is the Alcock’s Canal or the intersection of the ligaments, I do not feel enhanced or sharp pain. (Indeed, no form of palpating the pelvic floor reproduces the symptoms.) A 3T MRI from HSS is unremarkable except for large varices in the Alcock’s Canal, and I’ve now had those varices treated with a sclerotic agent with no effect.

At the same time, if it’s a muscular issue compressing the nerve that would not respond to surgery, it’s hard to understand why it would last unrelentingly for a decade (and seemingly will last forever) and be only on the left side.

If I could guarantee that surgery would not make me worse, I would do it, even if there was a high chance that it would not make me better, because the continuing symptoms are very frustrating. But the possibility that I could go from in-pain-and-uncomfortable-but basically-normal to some worse state of functioning has dissuaded me thus far.

[Violet M]

Well, that's a tough position to be in and I'm sure you've agonized over the decision many times. I think your reasoning makes a lot of sense though. I have often said that you should only consider surgery if your quality of life is already so bad that you are willing to risk getting worse.

What about nerve blocks -- did you ever have temporary relief on the left side from a nerve block?

Violet