Health Organization for Pudendal Education

Hi Karyn,
It's the Pudendal nerve becuase it passes through the ischial tuberosity(the sitting bone area) and everytime we sit ,it comes under pressure.Dr. Quesada never gave me an answer why I developed pain after my nerve block.He also flared my right Pudendal nerve so badly that it took two years for the nerve to actually calm down.Before the injections,I had never experienced pain in my sitting area.
It is quite possible that his blocks gave me scar tissue near the Pudendal nerve in the Alcock's Canal or maybe the blocks simply made my Pudendal nerve worse.

Best Regards,
Ali

Hi Ali!
Hmmm ... no, I never got an explanation, either. Nor did I get an explanation for my bowel system shutting down for 3 days. Maybe he missed his mark on us? Nicked the nerve? All I know is, prior to my last round of blocks, while it was painful for me to sit (internal pain), I did not experience this "sit bone" pain.
Thanks very much for your input. I'm a little concerned that you've had surgery after the block and still have the sit bone pain. Maybe it can be addressed/corrected using the TG approach?
Warm regards,
Karyn

Hi Karyn,
Dr. Hibner is my last hope now since he is the only one who does both redos of TG and TIR approach.I will keep all of you updated with my appointments with him next week.In addition,I will try my best that he does get in contact with Dr. Hollis Potter.Since, he is a authority on PNE,his getting in touch with Dr. Potter is very pivotal in PNE imaging.I believe they can both benefit from each other.
We, the patients can only help Dr. Potter to a certain extent with PNE imaging.

I believe that the only improvements that I had from Dr. Bautrant were in the first three weeks after surgery other than sitting which became worse after surgery.

Warmest Regards,
Ali

Hi Ali,
I wish you the very best with your upcoming appointments! I have such high hopes for you! We've all been through a lot with this condition but you have endured more than anyone should have. I'm hoping you'll be able to communicate with us while out in AZ and that you're successful with connecting Dr. Hibner with Dr. Potter.
I'm cheering you on, Ali!
Warmest regards,
Karyn

Ali,

Did you have an MRI report prior to having surgery with Eric Bautrant? if so, what did that report say?

Catherine

Hi Catherine,
I wasn't aware of any radiologist who could do MRI imaging of the Pudendal nerve or the artery with the exception od Dr. Filler whom I couldn't afford.I wish that I had known about Dr. Potter before I proceeded to France.
However, I did sent the images of Dr. Potter to Dr. Bautrant to cross check whether they were correct or not about three months ago.
His only response was that he doesn't disagree with her report,but I should know how to differentiate between scar tissue and seclerosis of the tissue and then he stopped communicating with me.

Anyway,it doesn't mattter know because the MRI tool has proven to be an accurate tool so far,and it shows that my Pudendal nerve is entrapped in the Sacrotuberous ligament and it's dorsal branch is entrapped in the scar tissue which are the areas Dr. Bautrant doesn't access anyway.

Best Regards,
Ali
PS
In the opinion of my urologist,Dr. Bautrant did his best to release the Nerve in the Pudendal Canal,but he fell short in decompressing the nerve at the falciform process of the Sacrotuberous ligament which also led to the re-entrapment of the Pudendal nerve at the Alcock's Canal.In addition,the entrapment of the dorsal branch of the Pudendal nerve in the scar tissue wasn't addressed.

Dear Catherine,
I would also like you to compare my MRI with Pianogal's MRI which is as follows.She had surgery with Dr. Bautrant as well.But as you can see that she has surgical scar tissue whereas my Pudendal nerve is still entrapped in the scar tissue.

MRI of the pelvis.

MRI of the pelvis was performed utilizing coronal fast inversion recovery followed by coronal, sagittal and oblique axial fast spin echo techniques. Additional oblique axial inversion recovery sequence was performed. Clinical concern is pudendal nerve entrapment. The patient has undergone multiple surgeries including C-section, trans-ischial pudendal nerve release as well as obturator internus transgluteal release surgery. Concern is compression of the dorsal nerve to the clitoris, particularly adjacent to the pubis.

There is scarring of the pelvic floor extending from the inferior margin of the perivaginal soft tissues toward the pudendal nerves in Alcock's canal bilaterally, and more prominent on the right. This is noted on series 7 images 15-19, adjacent to the transverse perineal muscles. There is focal scar surrounding the dorsal nerve to the clitoris at its posterior margin, particularly on the right. More proximally the fat planes of the pudendal nerves through the central and posterior margin of Alcock's canal are unremarkable. There is a symmetric appearance of the sacrotuberous ligaments and no scar formation is seen to surround the pudendal nerves at this point. More proximally, the coccyx is not deviated nor excessively anterior angulated. The branch of the pudendal nerve to the rectum is unremarkable. There is no presacral adenopathy. No precoccygeal soft tissue mass is seen. There is minimal resorption of the inferior margin of the pubic symphysis. The fat planes around the ilioinguinal and genital branches of the genitofemoral nerves are symmetric bilaterally. There is no scar formation surrounding the pubic symphysis affecting the regional nerves.

More superiorly, the pelvic floor muscles appear symmetric, albeit somewhat attenuated bilaterally. Adnexal cysts are not individually enlarged by size criteria. Nabothian cysts are noted.

Impression:
MRI of the pelvis demonstrates mild scarring of the pelvic floor, abutting the inferior margin of the pudendal nerves, in particular the dorsal nerve to the clitoris, right greater than left. The nerves more proximally appear preserved.

Best Regards,
Ali

Ali,

Do you think that Dr. Potter can see where you are entrapped along the nerve, so that you can decide between TIR and TR surgery. I mean if you are entrapped lower down the nerve, a person could have the less invasive TIR surgery. That would be wonderful to know.

Kate

Hi Kate,
I already had TIR approach with Dr. Bautrant in the beginning of this year which haven't showed any major improvements so far.Infact,it made my sitting worse and I lost my job as well.This MRI report of mine is seven months after
my surgery with Dr. Bautrant.

Best Regards,
Ali

Hi Kate,
I think she has proved to be right so far.That's one of the advantages of having a MRI done prior to surgery is to know where you are exactly entrapped and then take the approach accordingly.It would be a good cross check in the coming days for the patients who don't benefit from the surgery and give the surgeons an insight what went wrong.
It will also help the surgeons to modify their surgical approaches in order to make it less invasive and get better results

Best Regards,
Ali