Surgery risks

[rimrock]

What the are risk of PN decompression surgery? Dr Conway says the risks are failure and infection. I find that are to believe.

[jaxi123]

I had 2 failed PNE surgeries and re-entrapped with scar tissue. Devastating and I am doctorless!

[Violet M]

I agree with Dr. Conway that those would be the most likely risks, but there is always a risk with any surgery of possibly getting worse, so you can't entirely count that out. That's why I think it is so important before you try surgery to be quite certain that you actually have a nerve entrapment before going the surgery route. And it makes sense to try conservative therapies first if you can.

Violet

[rimrock]

What I find frustrating is that he wouldn't even mention the risk of getting worse. Maybe it's a small risk but it should be mentioned. He kind of seemed like a used car salesperson but maybe I'm just too jaded and afraid to pull the trigger.

[rimrock]

It's frustrating that there aren't more practitioners offering this treatment.

[Violet M]

Yes, it's frustrating. Maybe you could have a phone consultation with one of the other surgeons to get a second opinion?

Violet

[rimrock]

Yes, I had one with Hibner. He's too expensive. Are there any others that take insurance?
Violet, what are your thoughts are the use of a pudendal nerve block as a diagnostic? Why aren't those being done to diagnose? What's the literature say?

[Violet M]

I think Hibner and Conway use the same surgical approach - - the TG approach with maybe some minor modifications. Did Hibner think you were a candidate for surgery and if so, did he explain what the risks are?

In the US, I'm not sure which other doctors take insurance. I think if you have the surgery in Europe, it might be cheaper than in the US if you have to pay for it yourself. Laparoscopic surgery is used by some of the European doctors.

My understanding is that pudendal nerve blocks are important as a diagnostic tool for pudendal neuralgia and especially, if you are considering surgery, they are important in helping to confirm a diagnosis of pudendal nerve entrapment. Using the Nantes Criteria, a positive nerve block is one of the essential criteria for determining a nerve entrapment.
https://www.pudendalhope.info/wp-conten ... iteria.pdf
https://pubmed.ncbi.nlm.nih.gov/26999519/
Pudendal nerve blocks containing steroids are no longer considered beneficial by some major medical organizations, however, nerve blocks containing an anesthetic such as marcaine can be valuable in determining whether you could have a nerve entrapment.
https://pubmed.ncbi.nlm.nih.gov/39019502/

I think most of the surgeons require nerve blocks prior to trying surgery. I can't say for sure which surgical approach is the best. There is a recent meta-analysis that concludes the laparoscopic approach appears most promising for pain relief, but it also concludes more research is needed. The analysis included perineal, laparoscopic, and transgluteal surgical approaches. https://pubmed.ncbi.nlm.nih.gov/38942945/
I personally know more people who got well with the TG approach, but that is anecdotal and not a scientific conclusion. I'm not sure we have enough data to really conclude which approach is the best. The laparoscopic approach exhibited a 16% complication rate, but it didn't go into detail on what the complications were and whether they were major or minor. If you could get access to the full article, it might say.

Violet