Health Organization for Pudendal Education

Hello, I have ~ 5 years experience of pudendal neuropathy caused by weightlifting, tried everything except decompression surgery.
Before I come to doctor for surgery, can anyone here advice me, how can I understand the exact place of entrapment? Which ligament causes the entrapment in my case?

In Russia we have doctor Dmitri Chagava (he learned to deal with PNE from dr. Antolack) who performs pudendal blocks and pudendal decompression surgery, he told that during such operations ST ligament is usually cut (not in all cases, but very often). I also try to connect dr. Eric Bautrant who uses TIR approach, but how can I understand if his method is useful in my case?

My symptoms are:
1) dragging pain in the right testicle/scrotum
2) bad sexual sensivity, difficult to reach orgasm. sometimes I don't feel any pleasure while having sex. But skin sensivity in not reduced.
3) discomfort in the perineal area, at the buttock branch of pudendal nerve
4) urethral muscles spasm

Hi Streetwise,

I don't know of any way to know for sure the exact place of entrapment or which ligament is causing the entrapment. Typically the nerve is compressed between the ST and SS ligament so theoretically cutting just the SS ligament frees the nerve, but for some people the nerve is entwined in the ST ligament. I don't know of any way to predict that before surgery.

A few years back we compared the number of success stories from the TG approach (used by Dr. Antolak) vs. the TIR approach used by Bautrant. I don't remember the exact numbers but based on member who had posted on the English pudendal forums, men seemed to have better results with the TG approach. It was not a scientific survey -- just anecdotal from people's stories on the forums.

What I can tell you is that based on surgeon's reports, there is better visualization of the nerve and access to the ST ligament with the TG approach. If you already have pelvic instability, there might be some advantage to the TIR approach. But the TG approach is much more widely used.

I wish you all the best whatever you decide to do.

Violet

Violet M wrote:Hi Streetwise,

I don't know of any way to know for sure the exact place of entrapment or which ligament is causing the entrapment. Typically the nerve is compressed between the ST and SS ligament so theoretically cutting just the SS ligament frees the nerve, but for some people the nerve is entwined in the ST ligament. I don't know of any way to predict that before surgery.

A few years back we compared the number of success stories from the TG approach (used by Dr. Antolak) vs. the TIR approach used by Bautrant. I don't remember the exact numbers but based on member who had posted on the English pudendal forums, men seemed to have better results with the TG approach. It was not a scientific survey -- just anecdotal from people's stories on the forums.

What I can tell you is that based on surgeon's reports, there is better visualization of the nerve and access to the ST ligament with the TG approach. If you already have pelvic instability, there might be some advantage to the TIR approach. But the TG approach is much more widely used.

I wish you all the best whatever you decide to do.

Violet

Hello Violet, thanks for your reply. Dr. Dmitri told me that after operation if the ST Ligament is cut it is not recommended to do some sports, because it will cause pelvic instability. Do you know anything about such restrictions?

As I see, You visited dr. Bautrant in France and made decompression surgery. Can you please tell me the approximate cost of such operation?

I'm not sure if you would have to be more careful about sports if you had the ST ligament cut. There have been a few men who posted that the TG surgery caused them to develop SI joint dysfunction. What kind of sports did you want to do? It might depend on your age and how good your ligaments are to begin with.

My surgery from Dr. Bautrant was almost 13 years ago. It was about 6000 euros then but expect it is more now. I don't like the TIR approach for males because the incision is in the skin between the scrotum and anus and I think the access to completely releasing the nerve is not as good as with the TG approach. Do you know if Dr. Dimitri cuts the ST ligament lengthwise or across the ligament? For awhile Dr. Antolak was cutting a window in it lengthwise to preserve the ligament. But I recently read an article that it doesn't matter because the ligament grows back. I have no idea how this happens. I posted the abstract here: http://www.pudendalhope.info/forum/view ... =23&t=8275

Violet

Violet M wrote:I'm not sure if you would have to be more careful about sports if you had the ST ligament cut. There have been a few men who posted that the TG surgery caused them to develop SI joint dysfunction. What kind of sports did you want to do? It might depend on your age and how good your ligaments are to begin with.

I'm 29. But I feel myself like 18, if there was no such problem like entrapment )) I like fitness, football, etc.

Violet M wrote:My surgery from Dr. Bautrant was almost 13 years ago. It was about 6000 euros then but expect it is more now. I don't like the TIR approach for males because the incision is in the skin between the scrotum and anus and I think the access to completely releasing the nerve is not as good as with the TG approach. Do you know if Dr. Dimitri cuts the ST ligament lengthwise or across the ligament? For awhile Dr. Antolak was cutting a window in it lengthwise to preserve the ligament. But I recently read an article that it doesn't matter because the ligament grows back. I have no idea how this happens. I posted the abstract here: http://www.pudendalhope.info/forum/view ... =23&t=8275

Dr. Dmitri Chagava told that it depends on a case. He cuts the ligament according to the situation. He told that sometimes he released the nerve and packed it in a cover to defend from collision with ligaments. I also believe that Dr. Bautrant is very talented with his skills and experience in TIR approach even he operates a male.

By the way, can you please tell me which kind of pain did you feel if dr. Bautrant helped you? I think I have a place of entrapment somewhere near TIR approach cut due to my feeling. Did you felt pain or discomfort somewhere between anus and vagina as well?

I agree with you that Dr. Bautrant is very talented. My pain was on the right side of the vagina. I did not have rectal pain. Dr. Bautrant said it was the perineal branch of the pudendal nerve that was affected the most. When Dr. Bautrant pressed on the pudendal nerve at the ischial spine via the vagina, that was the worst place of knife-like pain. Your doctor should be able to press on your pudendal nerve at the ischial spine via the rectum (for a male) to see if it is painful there. According to the Nantes criteria, pain on one side is more likely to be an entrapment. http://www.pudendalhope.info/sites/defa ... iteria.pdf

Violet

Violet, one more question please )

Did you have permanent pain or sometimes it disappeared and returned after some time?

Did alcohol help you?

At first it was mild and it got better for awhile. Eventually it got very bad and didn't go away. For some people it can be mild and come and go for many years, depending on their activities.

I never tried alcohol because I don't drink, but some other people says it helps them to relax and sleep better.

Violet