Publications

Pudendal Nerve Surgery Intraoperative Electrophysiological Exploration

Eric DeBisschop and Eric Bautrant

This publication explores how the diagnostic testing can help with intraoperative procedures.

"Intraoperative Electrophysiological exploration of the Pudendal Nerve appears to be an important and valuable method for the success of surgical procedures."
 

Pudendal Nerve Entrapment

Dr. Robert

"Anatomic study of the pudendal n. and its branches led us to a multidisciplinary description of the typical features of perineal pain
previously regarded as idiopathic, to analyse it by a neurophysiologic method, and to treat it as a canalar syndrome favorably if
transiently influenced by infiltrations.
The surgery of the pudendal n. is currently the subject of a randomised program comparing a series of operated patients with one
of patients treated conservatively."

Treatment for Persistant Pain following Pudendal Nerve Decompression Surgery

Dr. Jerome Weiss

"Successful treatment of persistent post decompression pain requires comprehensive multidisciplinary therapy. The level of pain a patient experiences is the sum total of nerve injury, regional myofascial trigger points, connective tissue restrictions and adverse neural tension, deficient pain modulators and stress. To further complicate the picture, all of these aforementioned factors can perpetuate symptoms by initiating a vicious pain cycle. Some pain flares during the recovery phase can be attributed to the failure to address all of the issues that comprise the whole. An analogy is that of cutting one fiber in a spider’s web which will not release its prey any more than treating one pain component will release the patient from the web of pain. Freedom from pain can only occur when all of the links are severed, since treatment of every component is essential in decreasing the underlying central sensitization."
 

Complex Pelvic Pain Syndromes

Charles W. Butrick, M.D.

"One of the keys to these complex syndromes is the treatment of all sources of pain and dysfunction. Yet, our biggest challenge is to identify the characteristics that suggest the source of the pain has left the end organ and has become centralized or neuropathic in origin. These characteristics include symptoms of multisite visceral hyperalgesia and an allodynic exam. When this has occurred, it is important that we design interventions that will not further up regulate the sacral cord [18] (such as doing repeated surgeries), but instead down regulate the neuropathic changes by decreasing the “volume of pain” that the spinal cord sees so that the patient’s own modulating pathways can hopefully handle what is left behind."
 

Preliminary study on Doppler ultrasonography of internal Pudendal Vessels in
pudendal neuralgia

Dr. Eric DeBisschop

"At least most of the patient with Pudendal neuralgia symptomatology had
hemodynamic disturbance: 76% with less arterial velocity on the distality of the internal pudendal common trunk and 60% with pelvic veinous dilatations."

The Role of Physical Therapy in the Treatment of Pudendal Neuralgia

Stephanie Pentegrast and Elizabeth Rummer, Physical Therapist

"Commonly, clinicians attribute the symptoms of pudendal neuralgia primarily to potential points of nerve entrapment. In actuality, the impairments extend well beyond the path of the pudendal nerve and include structural, muscular, and connective tissue dysfunctions. These impairments cause functional limitations and disability. It is primarily the role of a physical therapist to treat the musculoskeletal deviations, as it is the role of a psychologist to treat anxiety and depression and the role of a physician to prescribe medication and perform injections and surgery. The impairments associated with pudendal neuralgia require each of these interventions to yield a successful outcome for the patient."

A New Approach to the Physical Therapy Management of Chronic Management of Chronic Pelvic Pain

Elizabeth Rummer, MSPT

This article is very informative in looking at how Physical Therapy can help those whom suffer with Pelvic Pain. Different techniques are shown and there is detailed information about many aspects of physical therapy. Here is a prelude to this particular publication:

Connective Tissue Manipulation (CTM)
Myofascial Myofascial trigger point release trigger point release
Neural mobilization Neural mobilization
Lengthening of the shortened pelvic floor muscles
Correction structural/biomechanical
Deformities

PN Abstracts

Here is a wonderful abstract from some of the top PN experts in treating men and women with pudendal Neuralgia. Here is an excerpt from this particular article, written by R Robert, JJ Labat, M Bensignor, T Riant, O Hamel, S Raoul

"The investigation of patients suffering from perineal pain when sitting led the authors to consider that a tunnel syndrom due to ligamentous entrapment of the nerve does exist. An anatomical work was done among 5O cadavers and shew that the nerve trunk could be entraped at the level of the claw between the sacro-tuberal and the sacro-spinal ligaments and/or in the Alcock’s ( pudendal ) canal. In this area, both the fascia of the internal obturator
muscle and/or the falciform process of the sacro-tuberal ligament may diturb the course of the nerve."

Pudendal Canal Decompression in the treatment for Erectile Dysfunction

Ahmed Shafik, MD, PHD

This is written by what many call the founder of nerve decompression surgery. He has made quite an impact in the medical community. This particular article looks at how nerve decompression surgery can help those suffering from Erectile Dysfunction.

PCS included as cause of neurogenic neurogenic ED
treatment : : pudendal canal decompression
PCD PCD
simple simple
easy easy
no complications no complications
outpatient

Post-Operative Rehabilitation Protocol Following Pudendal Nerve Decompression

Stephanie Prendergast & Elizabeth Rummer, Physical Therapists

This is a very comprehensive publication about how to treat Pudendal Neuralgia with physical therapy, once surgery has been completed. There is alot of information and pictures that depict some of the physical therapy treatment protocols.

SURGICAL PUDENDAL NERVE DECOMPRESSION
THE ENDO-PELVIC TRANS ISCHIO RECTAL APPROACH

Dr. Eric DeBisscop and Dr. Eric Bautrant

This study explores the TIR approach for treating pudendal neuralgia. They examine the outcomes of those whom have already had Pudendal nerve decompression surgery, via the TIR approach.

Management of PNE requires a
multi-disciplinary approach:
• Physical Therapy, medical management, and lifestyle
modifications
• If conservative management fails, T.I.R procedure can give
improvement in up to 80% of patients with PNE
• Post-operative rehabilitation is required to normalize
secondary musculoskeletal dysfunction from nerve
entrapment

Observations on the Transgluteal Decompression of the Pudendal Nerve

Dr. Stanley Antolok

This publication looks at some of the benefits of utilizing the TG approach for nerve decompression and the outcomes of patients whom have had TG decompression surgery. This is a must read for anyone whom is contemplating surgery.

Trans Perenial Decompression

J. MOUCHEL, T. MOUCHEL, P. ZAKA

Otherwise known as Shafik's procedure. This study looks at how the trans perenial decompression surgery is conducted and some of the results that were seen in patients whom had trans perenial decompression surgery.

Study of Pudendal Nerve Location with Ultrasound

Peter Kovacs, Hannes Gruber

Finding the correct placement for nerve injections is a highly specialized technique. This a great study looking at how to best find the pudendal nerve with ultrasound.

"The major nerves of the extremities the pudendal nerve is a rather thin
nerve (0.6 to 6.8 mm), which may consist of separated trunks (2 trunks in 34.5
percent, 3 trunks in 6 percent) and is lying in deep topographical regions embedded in fatty tissue. So the nerve is not approachable with high frequency transducers on the one hand. On the other hand curved array transducers working on 2 to 5 MHz used for abdominal ultrasound can be used for depicting the most important site for pudendal nerve block, which is the course around the sacrospinous ligament and ischial spine, respectively."

New Method for the Treatment of Pudendal Neuralgia

This is some of the original work by Dr. Bautraunt.

"Pudendal Neuralgia is a particularly incapacitating affection. A part of only it's physio-pathological mechanisms can be explained: many parts are still mysterious: the treatment described here is complex and requires the collaboration of a multidisciplanary team."

Anatomical Basis of Chronic Pelvic Pain Syndrome: The Ischial Spine and Pudendal Nerve Entrapment

This article was written by Dr. Antolak

Dr. Antolak states:
 

" Future attention must be paid to 1) the transverse diameter of the ST and SP ligaments which compress the pudendal nerve 2) the dimensions of the greater sciatic notch (diameter and depth), correlated to age, weight, and body habitus; 3) the cross-sectional area of the greater sciatic notch and the piriformis muscle; and 4) sequential pelvis x-rays in youthful and maturing athletes to measure changes in position and appearance of the ischial spine."