Outcome Of Treating Pelvic Pain Of Neural Origin; Ten Year Experience With 200 Patients
Arnold L. Dellon, MD, PhD.
Johns Hopkins University, Baltimore, MD, USA.
Purpose: To provide evidenced-based surgical management of pelvic pain of neural origin from a ten-year outcome experience.Method: A ten-year review of the author's surgical experience with 200 patients is presented. Diagnosis was based upon patients' history and physical examination, 3T MR imaging, and nerve blocks. Surgical plan was based upon understanding which of the three pudendal nerve branches (dorsal, perineal, or rectal) was involved. Surgery was either neurolysis of a compressed branch, or resection of neuroma of injured branch. A novel "anterior" surgical approach permitted resection/neurolysis of dorsal and perineal branches when symptoms did not include the rectum.Results: In women, the most common operation was neuroma resection of perineal branches caused by episiotomy. In men, the most common operation was neurolysis of dorsal branch to recover loss of penile sensation due to cycling. In women, persistent genital arousal disorder was treated with bilateral neurolysis of dorsal branch to clitoris. Excellent results were obtained in 80% of patients, with another 10% achieving good results, including resumption of sexual intercourse, decreasing medication usage, and improved quality of life. Conclusion: In men or women with pelvic pain of pudendal nerve etiology, utilizing the surgical algorithm described, good to excellent results can be obtained in 90% of patients 
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