Health Organization for Pudendal Education

I know laprospic surgey is being done by Dr Marc Passover and Dr. Tibet Erdogru. Is there any surgeon doing this in U.S. Actually I thought I was having Piriformis Syndrome and consulted Dr Martin. But after evaluating me he said I dont have Piriformis related problems. He diagnosed me with Pudendal nerve entrament at OI. I had three pudendal blocks at ischial spine and at alcocks canal level, but did not find significant relief. Now he has asked me to consult with Dr Antolak as his endoscopic technique will not reach that far down to treat the PNE problem. Dr Martin gave me two publications from Dr Passover to have a look at it.

My only problem is burning sensation at the inner side of ischial tuberosity at the bottom of buttock and starting of thigh region and I dont have any other uro-genital problems. I am having this for 5 years. I have this burning after sitting for 20 to 30 mins and then I have to walk for 5 to 10 mins and it is back to kind of normal. I am in IT job and this is how I have been managing so far.

Murali

The only doc I know of in the US who does the laparscopic PNE surgery in the US is not listed on our website list of docs due to complaints against his liscense that were listed on the state licensing board website.

Violet

Dr. Israel Chambi from Santa Ana Ca. He performed my surgery laprascopic. He operated on my left side in May. I will be going back in Oct. He will do my right side nerve decompression. I feel a change for the better since last surgery.

I was having problem with my old user id pmurali1 so I created this new one Pudendal. I emailed Dr Tibet Erdogru regarding laproscopic approach and he replied back fast with my questions. Below is my mail to Dr and his reply. 80% success rate is encouraging one. I wish we have some laproscopic surgeon in U.S with this kind of success %. Below is my email an dhis answers.

I have burning sensation in my buttocks ( inner side of my ischial tubesosity) and also pain in my calf muscle for about 5 years . But I dont have urinary or sexual dysfunction symptoms. Only recently some times I have burning sensation in my anus area.

1) Is it possible for me to have PNE along with cluneal nerve entrapments?
Yes. Especially inferior cluneal nerve originated from sacral 1-3 roots can be effected combined with pudendal nerve (originated from s2-4 roots) at the same time. The other possibility you have the problem at the level of sacral roots. This has to be evaluated.

2) With your laproscopic appreoach will you be able to release other nerves or you will decompress only pudendal nerves.?
I can perform sacral roots neurolysis and decompression as pudendal nerve. In addition I can explore the other nerves (sciatic and int. obturator nerve) potential pathologies during the laparoscopic surgery. This is the one of the most important advantage of laparoscopic or robotic approach)

3) Since 90% of my pain is in buttocks area, will you specfically release pudendal nerve which is causing the problem in that area?
We have to laparoscopic approach to the sacral roots and pudendal nerves together. However I need 3 TESLA pelvic MRI before the surgery

4) How many surgeries have you done so far and what is the success rate?
I have performed more than 35 laparoscopic pudendal nerve and sacral roots neurolysis and decompression during the last 2 years.

5) How much time is needed to improve the symptoms after the Surgery?
Our results (who followed more than 12 months) the success rates about 80%. My last 10 cases the decompressed nerves protected from postoperative fibrosis and re-entrapment of the nerve by omental flap the success rate is about 95%.

6) Since you cut the sacrospinous ligament, will it not cause SI joint dysfuncton in the future?
After cutting the SSL, I always repair it after transposition of the nerve despite no risk for SI joint dysfunction

I too am interested in seeing Dr. Tibet Erdogru. It just seems that his method is still effective yet less invasive in terms of cutting through ligaments. My main symptom was vulvar burning and now it has gone into a flare on not gone down. I am now feeling pulling and pain. This is awful. I am going into year 3 and things aren't getting better. Has anyone ever gone there and had it done? I would like to read some publications on the success of his procedure.

Very interesting post, Pudendal. Thank you very much for sharing your exchange with Dr. Erdogru. I'm intrigued by his responses in regards to the sacral nerve roots. That seems to be the common denonimator with most of us; especially with those who have multiple symptoms.

pudendal wrote:1) Is it possible for me to have PNE along with cluneal nerve entrapments?
Yes. Especially inferior cluneal nerve originated from sacral 1-3 roots can be effected combined with pudendal nerve (originated from s2-4 roots) at the same time. The other possibility you have the problem at the level of sacral roots. This has to be evaluated.

As we're all aware, the PN arises from S2/S3. It makes sense that those of us with neuropathies in the lower extremities (myself included) could have other sacral nerve root pathology. How would he evaluate this before surgery, though? I've yet to find anyone with expertise in regards to the sacral nerve roots. Seems to be completely skipped over.
For instance, when you go for a lumbo-sacral MRI, they usually image L1 - L5, and stop at S1.
Have you already had a 3T MRI?
Best regards,
Karyn

I know what you mean Karyn. Although would it be true that because the sacrum is fused and there are no discs to herniate there, the main cause of any pathology would be a cyst or similar? Always allowing for no fracture or sacrum damage of course.
It would be interesting to find out if Dr Erdogru would need imaging prior to surgery or if he checks any spinal root problems laparoscopically during the op.
Good luck to all pursuing Dr E's surgery.
Take care,
Helen

helenlegs 11 wrote:Although would it be true that because the sacrum is fused and there are no discs to herniate there, the main cause of any pathology would be a cyst or similar?

Well, that's just it, Helen. It's very common for people with neuropathies to have these lower lumbar MRI's, looking for the abnormalities you mentioned. It appears that many of us do have some pathology, but nothing that would cause our problems. I really do think the sacrum is being overlooked as the underlying cause. Even without the "disc impingements", there could be other possible reasons why the sacral nerve roots become effected. Such as the sacrum being torqued, SIJD, fractures, tarlov cysts, etc ....
So many of us have other neuropathies, besides the PN. It would make sense to me to trace these nerve roots back to their origins and focus on THAT area (sacral).

I looked up Dr. Isreal Chambi on the CA Medical Board and Orange County Superior Court and found him as a defendent in multiple malpractice suits.

CA Med Board webpage shows two Malpractice Judgements in the amounts of $328,522.00 and $200,000.00.

CA Med Board also shows 2007 Hospital Disciplinary Action from Western Medical Center in Santa Ana, CA:
"Termination or revocation of staff privileges bases on poor judment in surgical decisions and delayed emergency surgeries".

Emily B.

Hi Emily,
I think everyone rightly needs to get all of the information at hand together and make their own minds up re surgery and obviously then with whom to have that surgery. A lady (the lovely Paulette) who does post on here from time to time may chime in as I know that she has recently had surgery with Dr Chambi.
She had done her research and was happy to go ahead and although it hasn't sorted all of her problems out, I think that she was happy with the outcome with regard to the areas this Dr. was able to address for her with surgery.
Thanks for posting this information. We all need the in put to make that difficult decision
take care,
Helen.