Health Organization for Pudendal Education

hi, just returned fromMRI of pudendal nerve by dr. Potter in NY whom definitely recommend if insurance covers it; anyway, she found varioceles, enlarged veins, in alcocks canal which are probably compressing pudendal nerve there. She's recommended a dr. Ducksoo Kim, here in boston area, in interventional radiology to treat this. Anyone familiar either with dr. kim or procedure that thery might do??? thanks,pdn

Most dr.'s would tell you that it is highly unlikely that the enlarged vein would cause any problems with the pudendal nerve. This is because the vein is a very low pressure system. Most of the pudendal dr.'s find that an enlarged vein is commonly found during surgery where there is an entrapment. It is thought that scar tissue encompasses the nerve and the vein (they run together with an artery and the whole complex is called the neurovascular bundle) thus causing the vein to swell. It is like a balloon filled with some water and if you tied a string around the middle of the balloon there would be bulges in the balloon around the string. I know Dr. Potter has recommended this approach with a couple of other individuals. I know one person, can't remember who, did have some procedure done to the vein and it didn't do anything. Hopefully, someone who has followed Dr. Potter's advice on the vein can respond to you.

alipasha may have gone to see ducksoo kim. He gave me the contact info.

When you sit, do you feel like you are losing circulation?

I believe Dr. Hibner's office might have begun doing something to shrink veins in the area... A's Mommy knows more about that.

Hi Pdn and Pionogal,
As to my knowledge the varioceles is a result of Pudendal Nerve entrapment in the Alcock's Canal.One of my Italian friends who had 3 Tesla MRI with Dr. Potter and then surgery with Dr. Bautrant was indeed entrapped in the Alcock's Canal and Dr. Potter's MRI showed that his varioceles were enlarged in the Alcock's Canal.

Dr. Ducksoo KIm visulizes the Pudendal artery/illionguinal artery and most of the other arteries for any blood bockagein the Pelvis.Although I don't think he has any remedy for them or how to approach the problem.

Kind Regards,
Ali

As nyt was describing, I have read a number of mrn reports showing the blood vessels were enlarged due to a back up of blood as the result of a/compression or entrapment. I think Dr. Bautant's dopplar studies are based on this theory.

In this thread http://tinyurl.com/3zc6lr2 Dr. Possover mentions an impingement on the sciatic nerve by an atypical vein and mentions 6 cases of vascular entrapments so maybe Dr. Potter is correct in her assessment that the blood vessels are impinging on the nerve.

Who knows -- it's back to the chicken and the egg -- which came first?

hi, thanks for all the interesting posts. My question is that dr. Potter's recent MRI didn't find any entrapment of the nerve in alcock's canal but only the varioceles with the assumption that they may be impinging on the nerve? If varioceles are often associated with entrapment, doesn't that entrapment usually show up on Potter's specialized pudendal MRI?? Is it worth getting an opinion from dr. ducksoo about whether further imaging of those varioceles helps guide further treatment?? May look into dr. Hibner's operation after get further opinion from my neurologist and pain specialist up here in boston. thanks again for the thoughtful responses, pdn

Hi PDN - was wondering whether you had any luck with treatment for the varicoles? Only ask cos my Potter MRI said something very similar.

pdn wrote: If varioceles are often associated with entrapment, doesn't that entrapment usually show up on Potter's specialized pudendal MRI?? , pdn

An entrapment might show up but might not. Unfortunately, we don't have any statistics yet as to how accurate the Potter MRI is for diagnosing an entrapment.

hi, thanks for recent, thoughtful posts. Sounds like dr. Potter's MRI often shows varioceles in the pudendal canal, and appears too soon to know if this is result of or cause of impingement and sebsequent pain? Hard to know what to do?? Waiting to hear from my dr.s in boston area as to their thinking; not clear yet what dr. ducksoo kim can offer; might send email to dr. Potter asking what percentage of her patients show varioceles and does she have any follow-up yet as to any treatment results?? pdn

Hi
Just jumped in to say that my Potter MRi also showed varicosities abutting the pudendal nerver bilaterally, (have to re check it to see whether the Alcocks canal was mentioned)..
Anyway her advice was to contact Dr Ducksoo for possible emobolization,She seemd to think these varicosities were causal for my severe sitting pain in peri area and gluts.. I also have IC like issues.
We found a doc at Columbia Radiology in NYC, I then had an MRI of adbdomen which showed more details on the veins,
He agreed to do the embolization procedure. I was skeptical as I had spoken to 2 PN surgeons,both said the embolization wouldn't help,--my own pelvic pain doc agreed with them. I
But my hubby and I figured embolization was worth a try as I had symtoms that equated with pelvic congestion, the MIRs showed it. and we wanted to avoid surgery if possible.
The doc said he could do one side at a time and see what results were..
I did it in May and did NOT see any change im my symptoms.. We have since considered doing the right side as well, (forget why we didn't start on right) as my pain is mostly there; but my gut feel is that it wouldn't help, and frankly lying on that table for the emboliaztion was so painful -- butt pain) during and after.
So, I am confused... MY MRI sounds very much like Shawn's so if you are reading this I would love to exchange ideas with you Shawn! I have since done other interventions but that's for another post!
I have thought of going back to Potter and consult about all of this, as so many folks here really go by her MRI..
She never used the the words entrapment just variocosities abutting the PN, etc etc so what does this mean with relation to entrapment?
Would appreciate any comment.
Best regards

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