Health Organization for Pudendal Education

Dear Violet,
The surgeries aren't successful because they aren't addressing all the points of compression.Why didn't Dr. Bautrant not address my dorsal nerve issue and even refused to do my right side saying that it is a myofascial reaction from the left.Now my sitting pain on the right is worse off than the left.I wish that I had something positive to report.

All the surgeons are claiming that they have done 600 + surgeries like Ansell,Robert,Bautrant etc and how can they forget how to decompress the branches of the Pudendal Nerve.
Some are butchering ligaments with no regard to the patients health and some are giving Optimistic numbers.It's a bloody circus.

But let's not deviate from the main subject and I believe those are valid questions that I posted and should be asked at the respective conference and Dr. Bautrant should answer them honestly.

Regards,
Ali

A public forum on chronic pelvic pain and PN will be held on the evening prior to the Scientific Conference . See attached:

I will be attending the upcoming seminar in Sydney Australia. Thursday 17th and Friday 18th Feb.2011

I have a few questions already from Ali. If anyone else would like to add their questions for Dr. Bautrant or Prof. Vancaillie can you please post them here. I will make a list and endeavor to get them answered by the doctors.
That also goes for Physios. and Radioligists.

I will do my best to get as much updated information as possible.

Catherine

Great. I do have a few questions.

1) If you read Prof. Robert's papers he writes that cutting the ligament and the transposition of the pudendal nerve give a few more centimeters of slack to the nerve so it doesn't get entrapped again. Obviously the TIR surgery does not transpose the nerve. I would like to know what the TIR surgeons think about Prof. Robert's statement.

2) Prof.Robert does cut the nerve to the obturator internus now (not the obturator nerve) from what I understand. It seems to be a recent addition. I am post surgery and feel that my main problem is obturator spasms. It seems that this recent addition does prevent a continuation of spasms of the obturator internus muscle. Again, I would like to know if those surgeon are thinking about this extra procedure and if they feel there is same drawback doing it.

3) The Obturator nerve goes through the Obturator muscle in the obturator canal. The obturator nerve does innervate the adductor muscle. Some of us have leg pain. I would like to know if those doctors believe an entrapment or even just a compression of the obturater nerve in the obturator canal is possible.

4) Some doctors (Filler, Weiss) believe that the piriformis can be involved in the entrapment of the pudendal nerve. Is it an observation shared by Dr.Bautrant and Dr.Vancaillie?

Thanks.

Thanks Ezer . I'm compiling the questions and plan to forward them to the organizers of the conference so that the doctors will have time to read them over. I've also posted this same message under 'Australia & New Zealand ' section.

See attached.
Catherine

Hi Catherine,

Can you add this to the list of questions:

Is it possible to decompress the distal nerves to the rectum?
If decompression of the distal nerves (rectal/perineal/clitoral) is possible, how is scar tissue prevented post surgery since it's such a small area? Would nerve wrap be used?

Update on Pelvic Pain Conference:

The seminar was was attended by health professionals from around Australia who have an interest in chronic pelvic pain conditions. A huge turn out with the auditorium full to capacity and more sitting on the stairs down the aisles.
A public forum was held on the evening before with many questions from both men and women.

I managed to get some answers from Dr. Bautrant (quite difficult as he was extremely popular among the medical staff.) I had to grab him for a few minutes.

1 Transposing the nerve. Dr. Bautrant said that he does not touch the nerve itself but removes the problem of entrapment around it. He'd rather not touch the nerve due to possible further damage.

2. Cutting the nerve to the OI muscle: Dr. B said there are other treatments for obturator spasms. He said cutting the nerve to the OI is new research and has no data to date.

3. Entrapment of OI . Yes it is possible for the OI nerve to be trapped or compressed. Pain on the inside of the leg would indicate OI nerve issues.

4. Piriformis. Yes, the piriformis can be involved in the entrapment of the PN.

5. Falciform Process: is the fascia of the Alcocks Canal. He does not cut the Sacrotuberous ligament. This is why he does TIR approach so as to avoid cutting the Sacrotuberous ligament.

6. Dr. Aszmann & Dr. Dellon. Dr. Bautrant keeps in touch with these researchers and knows of their work on the decompression of the dorsal nerve. To date there is no data of efficacy and he has no plans to do this type of release. All of his surgeries are Alcocks Canal & SS ligaments as that is where the majority of entrapments seem to be found.

7. Young Children with symptoms of PN. Dr. B said that he would never do surgery on a young child. He has seen children in his clinic and all have been muscle related issues. Factors such as inappropriate toilet training when the child is a toddler. ie being punished for soiling their pants or from constant anger and verbal abuse by parents when the child wets or soils in their pants. Young children then develop a 'holding back' muscle tightness that develops into pelvic muscle dysfunction. Can then have PN symptoms. He also stressed that sexual abuse must be investigated.

The seminar was very well presented and it was great to see so many health professionals learn about PN. I think it will be moved to a bigger venue next year. I was asked to fill out a survey and I suggested that the seminar be taken to other cities around Australia & New Zealand.

Hi Catherine,
It was wonderful to be able to speak with fellow sufferers at the public seminar. My partner and I felt the evening was extremely valuable and provided us with pieces of the jigsaw of PNE which was quite reassuring. We were not originally aware of how so many of my physical symptoms are actually linked to this condition. I am going ahead with the trial stimulator, which I am hoping in the long term, will allow me to return to work. Thank you for taking the time to speak with Sam and I, we sincerely appreciated the sharing of your knowledge with us. Keep up the great work!!!!

Health & Happiness
Narelle

Please refer to the following Post.

AliPasha1 wrote:Dear Catherine,
Thank You very much for calrifying all the questions for everybody else.I really appreciate all your help and efforts.

catherine a wrote:Update on Pelvic Pain Conference:

5. Falciform Process: is the fascia of the Alcocks Canal. He does not cut the Sacrotuberous ligament. This is why he does TIR approach so as to avoid cutting the Sacrotuberous ligament.

Dr. Hollis Potter found that my
Pudendal Nerve was entrapped in the falciform process of the Sacrotuberous ligament.That means that the nerve is still entrapped in my falciform process of the Sacrotuberous ligament and that's why he couldn't access it.I would be needing a redo PNE urgery with Dr. Hibner.THat's what i was afraid of.

6. Dr. Aszmann & Dr. Dell. Bautrant keeps in touch with these researchers and knows of their work on the decompression of the dorsal nerve wa[/quoter[/quote]

Dr. Hibner just performed a dorsal decompression surgery with Dr. Aszmann in AUstria and it wa valided that the dorsal nerve compression does exist.We are seeing a lot of dorsal nerve compression in a number of patients.

I apprecaite all the help once again.

Kind Regards,
Ali