Health Organization for Pudendal Education

Upcoming seminar in Sydney Australia. See http://www.whria.com.au/page.aspx?docid=162

Hi Catherine,
Can you ask three questions from Dr. Bautrant at the conference?

1)Does he address the entrapment of the Pudendal Nerve at the falciform process of the Sacrotubeorus ligament?If so how does he reach the falciform process of the Sacrotuberous ligament?

2)What is his view on Dr. Oskar Aszmann and Dr. Dellon's work on the decompression of Dorsal Nerve entrapment?

3)How does he plan he decompress the perenial and dorsal branches of the Pudendal nerve nerve after they branch out of the Alcock's Canal all the way to the Pubic symphysis?

I would really appreciate if you can ask him these questions.

Best Regards,
Ali

Ali,
To answer one of your questions, Dr. Bautrant goes through the Falciform process to access the nerve. He is able to visualize the SacroTuberous ligament through his Endoscope. He told me mine was healthy and unscarred, and the 3Tesla MRI confirmed that it was true.

Catherine,
If you go to the conference please do ask Dr. Bautrant if he can surgically release the Dorsal Nerve (to the Clitoris/Penis), do nerve blocks to it, or consider learning surgery for it.

Dear Pionogal,
I have seen the word "Sacrotuberous ligament" in his publications as well as in my report. I am not sure still whether he actually does addresses it surgically or not.The problem is if he adresses the falciform process,why do I have massive scarring around the falciform process of the Sacrotuberous ligament.And then what does he mean by the "falciform process".Is he refering to the Alcock's Canal area or just the falciform process of the Sacrotuberous ligament.I also asked him the same question after my surgery,but he didn't give me an affirmative answer and that has made me suspicious since that day.

I just want him to validate whether he does address the falciform process of the Sacrotuberous ligament or not during the surgery.

Warmest Regards,
Ali

Dear Pionogal,
I have seen the word "Sacrotuberous ligament" in his publications as well as in my report. I am not sure still whether he actually does addresses it surgically or not.The problem is if he adresses the falciform process,why do I have massive scarring around the falciform process of the Sacrotuberous ligament.And then what does he mean by the "falciform process".Is he refering to the Alcock's Canal area or just the falciform process of the Sacrotuberous ligament.I also asked him the same question after my surgery,but he didn't give me an affirnative answer and that has made me suspicious since that day.

I just want him to valudate whether he does address the falciform process of the Sacrotuberous ligament or not during the surgery.

Warmest Regards,
Ali

Ali, I don't know what Dr. Bautrant did during your surgery but in mine he shaved off part of the falciform process on both sides where the ST ligament attaches to the bone. For forum members who don't already know this -- there are two different areas of the ST ligament that need to be addressed during PNE decompression surgery -- the falciform process where it attaches to the bone and higher up at the ligamental grip where the ST and SS ligaments cross each other at the ischial spine.

As you can see in this picture http://en.wikipedia.org/wiki/File:Gray320.png where the ST ligament attaches to the bone at the bottom of the pelvis toward the center of the pelvis, that is the falciform process. It is near the alcock's canal.

Dear Violet,
You still have your surgical CD from Dr. Bautrant.Could you kindly check whether he accesses the falciform process of the Sacrotuberous ligament.You will know once he enters the Alcock's Canal which direction he takes.

If I remember correctly,Dr. Bautrant stated that the nerve cannot be entrapped in the Sacrotuberous ligament.

Warmest of Regards,
Ali

OK Ali, I will try to dig out my CD -- but it's not of my own personal surgery. I am quite certain that Bautrant told me he accessed the ST ligament at the falciform process and shaved some of it off and my surgical report says that he "sectioned hard fibers of the falciparous ligament".

My understanding of what Bautrant said regarding the ST ligament is that he does not access the ST ligament at the ischial spine area. I specifically asked him this question while I was observing him perform a surgery -- I asked "where is the ST ligament" and he said he can't see it or access it at the ischial spine. However, he did not say to me that the nerve can't be entrapped in the ST ligament. He said that if the nerve is compressed between the 2 ligaments at the ischial spine, cutting just the SS ligament will release the nerve. On certain patients he uses an endoscope if he is having difficulty accessing certain areas but he did not use one during my surgery. Of course, I was there over 6 years ago and he has since told me that he uses an endoscope more often now.

Hi Violet,
" sectioned hard fibers of the falciparous ligament" is what it says on my report as well.I think I will call him and ask him personally.Afterall,I am still feeling the same after 11 months after my surgery with him as pre-surgery.I am very frustated and angry at the moment.
He should be answerable that why I didn't improve.He specifically told me that I should be okay in a year or so,because my PN wasn't damaged or flattened.The doctors have to take responsibility for their work and give me a reason for not improving.

Warmest Regards,
Ali

Ali, I understand what you are saying. Dr. Bautrant tends to be an optimist, always reassuring the patient but no surgeon can guarantee that you are going to get better.