Health Organization for Pudendal Education

My doctor has recommended that I go for a consult for cryoablation of the ilioinguinal and iliohypogastric nerves. He has also suggested that if the cryoablation does not work that I should consider having the nerves removed. This is something that I know nothing about and I could use some advise. My doctor says that having this done will help with the genital pain that I have been having. He also said that these nerves really serve no important function so the removal would not affect the function of the genitals.
If anyone knows about this, please help me out.
Thanks
Mitch H

We've had people here get cryo on one or both of those nerves, Mitch, and it's helped. I believe Antolak's removed them but not sure who's done the cryo. These nerves are like the ones in your teeth that you can get a root canal of--they only cause feeling (and pain), they don't control any function like the PN does. Remember the PN is mixed--it controls feeling and function of sexual organs and sphincters for urinary and fecal continence. That's why it's not one that can be cut, frozen, or destroyed. You'd have a worse life without it than with it. Anyway, many people do have to chip away at their pain from different angles.

Celeste - do you know type of doctor typically would do cryoablation and/or neurectomy of these nerves? I have not had any luck finding someone

Grace Under Fire,
Dr Robert Long in Edina, MN is who is suppose to do mine. If you want more contact information just let me know.

Thanks Celeste, What you said was exactly what Dr Antolak told us. That the nerves really served no function. I guess I really just wanted to know if anyone else had it done. The injections that he did really helped. The pain was completely gone for several hours. It was very nice but the rectal pain was still there. Like you said, I guess I will just chip away at the pain, one step at a time.
Thanks, I know I can always come here for answers. You have a great website here. There are a lot of knowledgeable people here and they seem to care about helping others. You guys are a true blessing. I thank God every day that I have met so many great people like you. I don't think I could have made it this far without the support and help other people have given me and my wife.

HI,
I also need to have my ilioinguinal and iliohypogastric nerves addressed. I'll find out tomorrow for sure, but I was under the impression Dr. Conway performed surgery on these?
Grace: I thought I read on the previous forum that you did have surgery done by Dr. Conway on your ilioinguinals? Please correct me if I'm wrong ....
Warm regards,
Karyn

There are pros and cons in regards to cyroablation versus neurectomy of either ilioinguinal, iliohypogastic or genitofemoral.

Cryoablation is typically done in an outpatient setting or one day surgery center by an anesthesia dr. that specializes in pain management. It is minimally invasive compared to having a neurectomy. The biggest advantage of cryoblation over a neurectomy is you won't have the risk of developing a neuroma. In addition, you will have less scar tissue because you won't the larger incision that is needed for neurectomy. Less scar tissue is always better The biggest disadvantage of cryoablation is in a good percentage of individuals the pain comes back. I have seen a publication with the numbers but I can't find it right now. I'll look later and put the abstract up on this thread. Also, with cryoablation they won't be able to go in a find if it is scar tissue, suture, or surgical mesh that is entrapping the nerve and remove as much of the nerve that is entrapped. For the neurectomy they cut the nerve and stick the cut end into muscle so that it won't form a neuroma. The success of the surgical procedure is quite dependent on the skill of the surgeon as there is variation in the anatomy of the above 3 nerves, the surgeon needs to dissect enough of the nerve and get the end of the nerve embedded well within the muscle.

Anatomic Variability of the Ilioinguinal and Genitofemoral Nerve: Implications for the Treatment of Groin Pain

Matthias Rab, M.D., Johannes Ebmer, and A. Lee Dellon, M.D.
Vienna, Austria, and Baltimore, Md.

The differential diagnosis of groin pain must consider problems of the ilioinguinal and/or genitofemoral nerve. These nerves may become injured during hernia surgery
or lower quadrant surgical procedures. To treat injury to these nerves, it is critical to understand their anatomic variability. In the present study the pattern of cutaneous
nerve branches in the inguinal region was investigated through dissection in 64 halves of 32 human embalmed anatomic specimens. In contrast to usual textual descriptions, four different types of cutaneous branching patterns are identified: type A, with a dominance of genitofemoral nerve in the scrotal/labial and the ventromedial thigh region. In type A, the ilioinguinal nerve gives no sensory contribution to these regions (43.7 percent). In type B, with a dominance of ilioinguinal nerve, the genitofemoral nerve shares a branch with the ilioinguinal and gives motor fibers to cremaster muscle in the inguinal canal, but has no sensory branch to the groin (28.1 percent). In type C, with a dominance of genitofemoral nerve, the ilioinguinal nerve has sensory branches to the mons pubis and inguinal crease together with an anteroproximal part of the root of the penis or labia majora. The nerve was found to share a branch with the iliohypogastric nerve (20.3 percent). In type D, cutaneous branches emerge from both the ilioinguinal and the genitofemoral nerves. Additionally, the ilioinguinal nerve innervates the mons pubis and inguinal crease together with a very anteroproximal part of the root of the penis or labia majora (7.8 percent). The described patterns of innervation were bilaterally symmetric in 40.6 percent of the cadavers. The anatomic variability of both nerves has implications for all surgeons operating in the groin region and for those caring for the patient with groin pain. (Plast. Reconstr. Surg. 108: 1618, 2001.)

J Am Coll Surg. 2000 Aug;191(2):137-42.

Surgical management of groin pain of neural origin.
Lee CH, Dellon AL.

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Abstract
BACKGROUND: An approach to surgical management of the patient with groin pain is described based on our experience with 54 patients, six of whom had bilateral symptoms. History and physical examination are sufficient to relate the pain to one or more of the lateral femoral cutaneous (LFC), ilioinguinal (II), iliohypogastric (IH), or genitofemoral (GF) nerves.

STUDY DESIGN: Retrospective analysis of patients with groin pain is reported, with emphasis on cause, involved nerves, and outcomes of operative management. The LFC was decompressed. The II, IH, and GF nerves were resected. Outcomes were graded as excellent, good, and poor in terms of pain relief and functional restoration.

RESULTS: For the entire series of patients with painful groins, excellent relief of pain was achieved in 68% and restoration of function achieved in 72%. Ten percent had a poor result. The best results were for II and IH, which were 78% and 83% excellent for both pain relief and restoration of function, with 11% and 17% having a poor result, respectively. The worst results were for the small group of patients with a GF problem, 50% of whom had an excellent and 25% a poor result. Patients who were likely to get an LFC entrapment were those with a nerve located above or within the inguinal ligament. Complications included bruising and cautery injury to the LFC.

CONCLUSIONS: Groin pain of neural origin can be relieved with a high degree of patient satisfaction by considering whether one or more of four different nerves are the source of that pain, by realizing that symptoms can be referred to regions other than the groin, such as the pelvic viscera (IH), the knee (LFC), and the testicle (GF), and by treating the appropriate nerve(s) by either neurolysis (LFC) or resection.

Thank you, Nyt. How upsetting ....
I'm still hoping to hear back from GraceUnderfire!
Warm regards,
Karyn

I'm trying to find a chart that shows the pelvic nerves. It was of a woman standing up and everything was clearly labeled, in color. Can't find it for the life of me now! I'd like to take a look at the ilioinguinals, cluneals, etc ....
Anybody got anything?

Sorry it has taken me so long to respond. Between pain and then having a knee problem - I have just been too miserable to get on pc.

Anyway . . . you are correct in that I had an ilioinguinal neurectomy by Dr. Conway. It was totally ineffective and I also developed a seroma that turned into a pseudobursa . . . .it hasn't been fun. While the PNE is my #1 priority, feeling like I am being cut in half all the time doesn't help!

Grace