Health Organization for Pudendal Education

I do know that Dr. Conway does surgery on the ilioinguinal but if you also have entrapments of the iliohypogastric and/or genitofemoral and/or lateral cutaneous femoral I don't know if Dr. Conway can address all those nerves. It is rare that the ilioinguinal is injured in isolation if it is due to a surgical procedure. I know Dr. Dellon will address the ilioinguinal and iliohypogastric during the same surgery but don't know if he would do decompressions or neurectomies on the other nerves during the same surgery. In other words, if all four nerves needed surgery can he do all four nerves during the same surgery? I will find that out during my visit. Once I have researched the different appoaches for these surgeries I will post again after my visit to Dr. Dellon.

nyt wrote:I am a patient of Dr. Hibner's and Dr. Howard's but I have multiple neuropathies and am looking for a way to try and narrow down which nerves I should have surgery on and which one's I should not, and minimize the number of nerve blocks. Also, for additional surgeries beyond pudendal I need ie ilioinguinal, genitofemoral, a different approach for the obturator nerve, or femoral decompression surgery .

Hi Nyt,
Aside from the obvious, physical pain you're experiencing, could you please tell me how you know you have problems in these areas? I'm very concerned I have more than PN issues and am afraid something will be overlooked. I asked Dr. Potter to re-review my MRI, with specific regards to the ilioinguals (and a couple of other areas) because the EMG I had in NH did record abnormal activity. This was her response:

The MRI demonstrated that you have scarring of the pelvic floor surrounding portions of the pudendal nerve, particularly on the left. Whereas there is no gross scarring in the vicinity of the ilioinguinal nerve, this does not mean that your symptoms are not real in that distribution. The imaging tests are limited by spatial resolution and sensitivity to depict what may be very subtle changes in nerve signal. At the end of the day, we treat the patient, not the MRI, but the study of 9/13/10 did demonstrate that you have entrapment of nerves, as stated.

Based on the nerve anatomy pictures I've looked at, my symptoms or areas of pain run along the same areas as yours.
Warm regards,
Karyn

Karyn, it is based on location of pain, abnormal neurosensory testing by Dr. Conway, physical exam, and some nerve blocks. I had a genitofemoral nerve block on the right side which worked great for some of my residual groin pain but did nothing for the numbness, tingling, and burning on the mon pubis. I see Dr. Howard in 2 weeks and will ask about the ilioinguinal blocks. We have discussed it in the past but I have not had any to date.

Thanks, Nyt. I've actually had a couple of series of bilat ilioingual blocks. Got maybe about an hour of decreased pain, but that was about it.

NYT,

Please describe the areas of pain or symptoms for the different nerves you speak of... i.e ilioinguinal nerve, femoral and so on....

Thanks!

Take a look at this link to a paper by Dr. Dellon because it has a picture and good short description of where the nerves innervate. It does not show obturator nerve which will give pain in the groin and on the anterior medial portion of the thigh as far down as the knee.

http://dellon.com/publications/ipns.bro ... te.2pp.pdf

Wow! This was a tremendous help! Upsetting and exciting to be able to visually match up these areas of pain.
Thank you, NYT!
Warm regards,
Karyn

Karyn, one of the challenges with pelvic pain is that the nerves can recruit other nerves and that is one of the reasons why it can be so difficult to pinpoint the origin of the problem. Even though they show a clear map in Dr. Dellon's publication there is overlap and some publications show some variations in areas of innervation compared to his publication. Also, Dr. Antolek gave a great talk at the International Urogynecology meeting in August 2010, available online to watch, where he stresses the importance of treating all neuropathies because if they aren't you won't get the fullest recovery possible. He talks about a couple of patients that their pudendal symptoms weren't markedly improved until he treated the ilioninguinal neuropathy. So much self-education!

Thanks, NYT. What you said about Dr. Antolaks presentation makes sense.

This is a brief article explaining Pressure Specified Sensory Device tests

http://ezinearticles.com/?A-Look-at-Pre ... id=3496957