2024 Transgluteal Surgery with Dr. Conway

[Violet M]

I can see several sides of this discussion....
From a healthcare provider's perspective they may not want to perform a surgery unless they are pretty sure there is a strong chance of success, unless of course they are just money-hungry, but the providers I know of are not like that. Honestly, with malpractice costs being through the roof, especially in some states, I admire any surgeon who even has the guts to do any type of surgery on anyone!
However, as Eraser said, from the patient's perspective if they are in a lot of pain and conservative treatments have not helped, they are likely to want to pursue a treatment even if it doesn't have a 90% chance of success. I was certainly in that category when I went for surgery.

[eraser]

I can see several sides of this discussion....
From a healthcare provider's perspective they may not want to perform a surgery unless they are pretty sure there is a strong chance of success, unless of course they are just money-hungry, but the providers I know of are not like that. Honestly, with malpractice costs being through the roof, especially in some states, I admire any surgeon who even has the guts to do any type of surgery on anyone!
However, as Eraser said, from the patient's perspective if they are in a lot of pain and conservative treatments have not helped, they are likely to want to pursue a treatment even if it doesn't have a 90% chance of success. I was certainly in that category when I went for surgery.

Well said Violet. From a provider perspective, it must be a nightmare especially when you end up with a group of patients that may have pudendal merve entrapment but there isn't one single test that is likely to be definitive, unlike other areas of surgery.

The UK approach is to simply pretend that that the condition doesn't exist and that conservative measures always works....even though the evidence says the exact opposite. In the UK the tests we do have available, are not done unless you can pay for it, even though we are already pay for our national health system. So for everyone outside of the UK that look on the UK as having a great model, think again.

I can only speak for the UK but sadly chronic pain conditions are simply ignored on the whole and people are told to "live with it" or instead to keep having treatments that don't work.

At the moment, I am in the process of trying to create a patient pathway myself, how ridicilous.

[Balenul]

Your input is much appreciated. Haven't had a chance to read that article yet but it looks very interesting. I am very lucky to be 90-some percent better since surgery but I had the trans-ischio-rectal fossa approach which doesn't seem to be in use anymore. From what I have heard, even Dr. Bautrant uses the laparoscopic approach now instead of the TIR.

Violet

So basicly he use abdominal laparoscopic now or a laparoscopic tir....that is best for perineal branch i think . It seems drs that can really decompress perineal branch fully at least in male are almost impossible to find....i suspect that branch in my case since my symptoms are just urinary.....but from what i saw 1 year wait time is madness for dr Bautrain ....he simply can t be so busy.I think he just work less atm.Ofc is his choice

[eraser]

Your input is much appreciated. Haven't had a chance to read that article yet but it looks very interesting. I am very lucky to be 90-some percent better since surgery but I had the trans-ischio-rectal fossa approach which doesn't seem to be in use anymore. From what I have heard, even Dr. Bautrant uses the laparoscopic approach now instead of the TIR.

Violet

So basicly he use abdominal laparoscopic now or a laparoscopic tir....that is best for perineal branch i think . It seems drs that can really decompress perineal branch fully at least in male are almost impossible to find....i suspect that branch in my case since my symptoms are just urinary.....but from what i saw 1 year wait time is madness for dr Bautrain ....he simply can t be so busy.I think he just work less atm.Ofc is his choice

There seems to be such a shortage in doctors that specialise in this, particularly surgeons!

[Balenul]

Your input is much appreciated. Haven't had a chance to read that article yet but it looks very interesting. I am very lucky to be 90-some percent better since surgery but I had the trans-ischio-rectal fossa approach which doesn't seem to be in use anymore. From what I have heard, even Dr. Bautrant uses the laparoscopic approach now instead of the TIR.

Violet

So basicly he use abdominal laparoscopic now or a laparoscopic tir....that is best for perineal branch i think . It seems drs that can really decompress perineal branch fully at least in male are almost impossible to find....i suspect that branch in my case since my symptoms are just urinary.....but from what i saw 1 year wait time is madness for dr Bautrain ....he simply can t be so busy.I think he just work less atm.Ofc is his choice

There seems to be such a shortage in doctors that specialise in this, particularly surgeons!

Other problem is they are super hard to decompress ( distal branches ) - ( Or if you manage scar tissue can compress them again )...Dr Itza told me and he worked with Bautrain alot so a entrapment there is a big problem...I just hope we can get newer and better neuromodulators for it sincer surgery is dangerous but i see even there progress is limited in last years I saw Dr De Watcher in Antwerp he is a top specialist in neuro modulation like Ken Peters in Usa ( they are also good friends ).He even invented a new stimulator for Pnerve but is new.....i simply hope he can help me this urethral issues are killing me ! He is also one of dr Jottard mentors

[eraser]

So basicly he use abdominal laparoscopic now or a laparoscopic tir....that is best for perineal branch i think . It seems drs that can really decompress perineal branch fully at least in male are almost impossible to find....i suspect that branch in my case since my symptoms are just urinary.....but from what i saw 1 year wait time is madness for dr Bautrain ....he simply can t be so busy.I think he just work less atm.Ofc is his choice

There seems to be such a shortage in doctors that specialise in this, particularly surgeons!

Other problem is they are super hard to decompress ( distal branches ) - ( Or if you manage scar tissue can compress them again )...Dr Itza told me and he worked with Bautrain alot so a entrapment there is a big problem...I just hope we can get newer and better neuromodulators for it sincer surgery is dangerous but i see even there progress is limited in last years I saw Dr De Watcher in Antwerp he is a top specialist in neuro modulation like Ken Peters in Usa ( they are also good friends ).He even invented a new stimulator for Pnerve but is new.....i simply hope he can help me this urethral issues are killing me ! He is also one of dr Jottard mentors

Good luck, I hope you recover as soon as possible. The symptons of PN are truly disabling.

[Balenul]

There seems to be such a shortage in doctors that specialise in this, particularly surgeons!

Other problem is they are super hard to decompress ( distal branches ) - ( Or if you manage scar tissue can compress them again )...Dr Itza told me and he worked with Bautrain alot so a entrapment there is a big problem...I just hope we can get newer and better neuromodulators for it sincer surgery is dangerous but i see even there progress is limited in last years I saw Dr De Watcher in Antwerp he is a top specialist in neuro modulation like Ken Peters in Usa ( they are also good friends ).He even invented a new stimulator for Pnerve but is new.....i simply hope he can help me this urethral issues are killing me ! He is also one of dr Jottard mentors

Good luck, I hope you recover as soon as possible. The symptons of PN are truly disabling.

ty.i wish you same.

[Balenul]

There seems to be such a shortage in doctors that specialise in this, particularly surgeons!

Other problem is they are super hard to decompress ( distal branches ) - ( Or if you manage scar tissue can compress them again )...Dr Itza told me and he worked with Bautrain alot so a entrapment there is a big problem...I just hope we can get newer and better neuromodulators for it sincer surgery is dangerous but i see even there progress is limited in last years I saw Dr De Watcher in Antwerp he is a top specialist in neuro modulation like Ken Peters in Usa ( they are also good friends ).He even invented a new stimulator for Pnerve but is new.....i simply hope he can help me this urethral issues are killing me ! He is also one of dr Jottard mentors

Good luck, I hope you recover as soon as possible. The symptons of PN are truly disabling.

Hmm.i see you also have prolly perineal branch problems ?

[eraser]

Other problem is they are super hard to decompress ( distal branches ) - ( Or if you manage scar tissue can compress them again )...Dr Itza told me and he worked with Bautrain alot so a entrapment there is a big problem...I just hope we can get newer and better neuromodulators for it sincer surgery is dangerous but i see even there progress is limited in last years I saw Dr De Watcher in Antwerp he is a top specialist in neuro modulation like Ken Peters in Usa ( they are also good friends ).He even invented a new stimulator for Pnerve but is new.....i simply hope he can help me this urethral issues are killing me ! He is also one of dr Jottard mentors

Good luck, I hope you recover as soon as possible. The symptons of PN are truly disabling.

Hmm.i see you also have prolly perineal branch problems ?

I am hoping that surgery will reveal and reverse the site of compression but unfortunately I have most of the symptoms apart from loss of sensation. Neuromodulation is certainly something that I am hoping to avoid, as it is not suitable for everyone, does not necessarily provide complete relief and can lead to a lifetime of healthcare as you can have all sorts of problems with leads etc. In my view it should be attempted last of all and is basically a palliative approach. Anybody who has told you different, clearly doesn’t understand the implications of neuromodulation. Additionally, other surgeons do not say that the decompression surgery is that difficult. It isn’t done often and that is the real issue.

I wouldn’t listen to anyone saying a certain branch is most difficult because it’s unhelpful for your wellbeing and it doesn’t mean it is impossible. Remember lots of difficult things are done on a daily basis, just because something is difficult doesn’t mean it shouldn’t be attempted. I am not commenting on any of the doctors you have mentioned but some have a tendency of inflating the difficulty to increase their ego’s and every single speciality says the same thing about the surgery they perform. They are paid a lot of money to be excellent. Also remember qualitative insights are a poor man’s evidence.

[Balenul]

Good luck, I hope you recover as soon as possible. The symptons of PN are truly disabling.

Hmm.i see you also have prolly perineal branch problems ?

I am hoping that surgery will reveal and reverse the site of compression but unfortunately I have most of the symptoms apart from loss of sensation. Neuromodulation is certainly something that I am hoping to avoid, as it is not suitable for everyone, does not necessarily provide complete relief and can lead to a lifetime of healthcare as you can have all sorts of problems with leads etc. In my view it should be attempted last of all and is basically a palliative approach. Anybody who has told you different, clearly doesn’t understand the implications of neuromodulation. Additionally, other surgeons do not say that the decompression surgery is that difficult. It isn’t done often and that is the real issue.

I wouldn’t listen to anyone saying a certain branch is most difficult because it’s unhelpful for your wellbeing and it doesn’t mean it is impossible. Remember lots of difficult things are done on a daily basis, just because something is difficult doesn’t mean it shouldn’t be attempted. I am not commenting on any of the doctors you have mentioned but some have a tendency of inflating the difficulty to increase their ego’s and every single speciality says the same thing about the surgery they perform. They are paid a lot of money to be excellent. Also remember qualitative insights are a poor man’s evidence.

In not sure what to say.My symptos are only urethral....if surgery fail i can have way more symptoms etc....so surgery is very risky.Imo neuromodulation if is working is a better step than invasive surgery.Surgery can make you much worse especialy since no one knows if you are entraped or not....No Potter and no one can tell you 100 % if is real entrapment.And this Hibner and others told me in my face.I live in Europe and i met Hibner in Poland.....my symptoms are urinary only in penis constant and horrible.So i suspect that deep perineal branch and also a long time primary bladder neck obstruction .....What are your symptoms ? You consider surgery ? And where you live ? ty .