Robotic or laparoscopic

[Carnation]

Yes I will ask about the scar tissue even though I have 4 different MRIs that show nothing

AND it’s really starting to bother my nerves right now that I literally have to travel 1000 miles just for a consultation.
How on earth did you manage that?

[eraser]

Yes I will ask about the scar tissue even though I have 4 different MRIs that show nothing

AND it’s really starting to bother my nerves right now that I literally have to travel 1000 miles just for a consultation.
How on earth did you manage that?

MRI's are unlikely to show anything, even if there was.

[Carnation]

I’ve had surgery so most likely I have scar tissue but like nerve entrapment I believe there’s no way to tell until you’re under the knife and hope this fixes it

[eraser]

I’ve had surgery so most likely I have scar tissue but like nerve entrapment I believe there’s no way to tell until you’re under the knife and hope this fixes it

Good luck!

[Violet M]

MRI's are unlikely to show anything, even if there was.

That is often true for regular MRI's but the Hollis Potter protocol has settings that enhance the nerve and is more likely to show if the nerve is entrapped. I've seen Potter mri reports that show scar tissue. There are some places around the country who use her protocol but I don't know if it's worth the extra expense if you are already pretty certain you have a nerve entrapment. Many people who had regular MRI's that show nothing abnormal have ended up having a nerve entrapment when they go for surgery.

[eraser]

MRI's are unlikely to show anything, even if there was.

That is often true for regular MRI's but the Hollis Potter protocol has settings that enhance the nerve and is more likely to show if the nerve is entrapped. I've seen Potter mri reports that show scar tissue. There are some places around the country who use her protocol but I don't know if it's worth the extra expense if you are already pretty certain you have a nerve entrapment. Many people who had regular MRI's that show nothing abnormal have ended up having a nerve entrapment when they go for surgery.

Sounds like they need to use this protocol everywhere.

[drummermikey]

So I'm very interested in the laparoscopic approach because I have failed two (2) transgluteal surgeries, one with D. Hibner back in I think 2011 and the other with Dr. Aszmann in I think 2017. There is a published Meta-Analysis titled: "Surgical Approaches for Pudendal nerve entrapment: insights from a systematic review and meta-analysis" with a publication date of August of 2024, and it is quite interesting. Basically, nineteen studies involving a total of 810 patients were included in the analysis. Just type in the title in quotes and you can read it and see what you think. The gist of it is that, BASED ON THIS meta-analysis, the transgluteal approach is by far the lease successful method; the laparoscopic by far the most successful. Of course, many factors go into things like this so none of this can be considered "absolute" per se, but I am looking at the POSSIBILITY of a final robotic-assisted laparoscopic surgery for a number or reasons. They are: 1) The laparoscopic method provides the surgeon with a very wide and deep field of view of the pelvic floor, NOT just the pudendal nerve, primarily proximal to the Alcock's canal, which is the case with the transgluteal approach. 2) The robotic system in use is almost without question the Da Vinci system, which has been around forever and is used by surgeons all across the globe because it is that good and in fact is produced by the world's leading manufacturer of surgical robotics. You just can't do better than Da Vinci. 3) The laparoscopic method is demanding of the surgeon because he/she must be anatomically knowledgeable, since the field of view offered the surgeon is extraordinary and if robotics are used, magnification can be 15X. What this means is that a skilled surgeon using this technique has the ability to correct in real time, during the surgery directed at the pudendal nerve, other nerve and/or impingement issues. My understanding is that the transgluteal method is more limited to, for example, clearing adhesions in or proximal to the Alcock's canal. The laparoscopic method requires a steeper learning curve than the TG method and it is because of this that I think many surgeons steer clear of it. Also, the Da Vinci Robotic systems would seem to be quite expensive IMO, so I'm guessing that many doctors may not want to invest in the technology when the TG method appears to be successful enough, but take that with a grain of salt because those are just my opnions.

One thing I cannot understand, cannot believe, is that nowhere (and correct me please if I am wrong) in the USA is there a surgeon who accepts insurance who uses robot assisted or non-robot assisted laparoscopic surgical technique on men. Really? Why? What exactly is the reason for this? Violet, please chime in. Are the sexes THAT different anatomically that it makes the surgery THAT much more difficult?!! Why should I have to go to Switzerland or Turkey for this procedure?

OP, if you're still with me after all of that, a quick search yields the following doctors that apparently offer robotic laparoscopic surgery for PN. Dr. Khashayar Shakiba in New Jersey, Dr. Ashley Gubbels at the Cleveland Clinic. FWIW, if I had it to do all over again, I would stay away from the transgluteal method and go with robotic assisted laparoscopic surgery, and I would make sure that I had received the surgery from the one surgeon who performed more of these exact type of surgeries per year than any other doctor. I am wishing you the best.

[Violet M]

One thing I cannot understand, cannot believe, is that nowhere (and correct me please if I am wrong) in the USA is there a surgeon who accepts insurance who uses robot assisted or non-robot assisted laparoscopic surgical technique on men. Really? Why? What exactly is the reason for this? Violet, please chime in. Are the sexes THAT different anatomically that it makes the surgery THAT much more difficult?!! Why should I have to go to Switzerland or Turkey for this procedure?
OP, if you're still with me after all of that, a quick search yields the following doctors that apparently offer robotic laparoscopic surgery for PN. Dr. Khashayar Shakiba in New Jersey, Dr. Ashley Gubbels at the Cleveland Clinic.

Not sure why that is. My guess is that it's partly a matter of what opportunities and experiences they've been exposed to and having the equipment available to them. Some health systems are more willing to provide needed equipment to surgeons. The other thing is that urogynecologists historically treat only women and I think pelvic pain is more common in women. Dr. Gubbels and Dr. Shakiba are both urogynecologists. There aren't any specialties I know of that treat only men. ( unless you do an internet search and discover that andrologists treat only men. How many people have even heard of an andrologist?)

FWIW, if I had it to do all over again, I would stay away from the transgluteal method and go with robotic assisted laparoscopic surgery, and I would make sure that I had received the surgery from the one surgeon who performed more of these exact type of surgeries per year than any other doctor. I am wishing you the best.

Back when I had surgery I don't think any of us had even heard of the laparscopic approach. The approaches to PNE surgery have been evolving and hopefully getting better over time. Since it's less invasive than the traditional approaches, it might make sense to give it a try if you can and if the surgeon thinks you are likely entrapped. But you may want to ask about scar tissue formation and how to prevent it if you tend to form scar tissue.

Violet

[eraser]

One thing I cannot understand, cannot believe, is that nowhere (and correct me please if I am wrong) in the USA is there a surgeon who accepts insurance who uses robot assisted or non-robot assisted laparoscopic surgical technique on men. Really? Why? What exactly is the reason for this? Violet, please chime in. Are the sexes THAT different anatomically that it makes the surgery THAT much more difficult?!! Why should I have to go to Switzerland or Turkey for this procedure?
OP, if you're still with me after all of that, a quick search yields the following doctors that apparently offer robotic laparoscopic surgery for PN. Dr. Khashayar Shakiba in New Jersey, Dr. Ashley Gubbels at the Cleveland Clinic.

Not sure why that is. My guess is that it's partly a matter of what opportunities and experiences they've been exposed to and having the equipment available to them. Some health systems are more willing to provide needed equipment to surgeons. The other thing is that urogynecologists historically treat only women and I think pelvic pain is more common in women. Dr. Gubbels and Dr. Shakiba are both urogynecologists. There aren't any specialties I know of that treat only men. ( unless you do an internet search and discover that andrologists treat only men. How many people have even heard of an andrologist?)

FWIW, if I had it to do all over again, I would stay away from the transgluteal method and go with robotic assisted laparoscopic surgery, and I would make sure that I had received the surgery from the one surgeon who performed more of these exact type of surgeries per year than any other doctor. I am wishing you the best.

Back when I had surgery I don't think any of us had even heard of the laparscopic approach. The approaches to PNE surgery have been evolving and hopefully getting better over time. Since it's less invasive than the traditional approaches, it might make sense to give it a try if you can and if the surgeon thinks you are likely entrapped. But you may want to ask about scar tissue formation and how to prevent it if you tend to form scar tissue.

Violet

I have heard of andrologists but they are very unlikely to be interested in PN, as it is a sub speciality of urology. Urologists on the whole are very disinterested in PN. It's a bit odd though why urogynecologists seem to have more of an interest in PN.

[Violet M]

I have heard of andrologists but they are very unlikely to be interested in PN, as it is a sub speciality of urology. Urologists on the whole are very disinterested in PN. It's a bit odd though why urogynecologists seem to have more of an interest in PN.

That's pretty incredible that we don't know of one andrologist who treats men with pudendal neuralgia. Especially given the definition of andrology in wikipedia.

https://en.wikipedia.org/wiki/Andrology

Andrology (from Ancient Greek: ἀνήρ, anēr, genitive ἀνδρός, andros 'man' and -λογία, -logia) is a name for the medical specialty that deals with male health, particularly relating to the problems of the male reproductive system and urological problems that are unique to men.

If I remember correctly, Dr. Antolak was a urologist, but he was one of a kind -- one of the earliest pioneers in treating PNE in this country.