Symptoms of chronic pelvic pain compound specialists in urology, gynecology, neurology, colo-rectal surgery, pyschiatry, pain management as algology. Pudendal neuropathy is a polysymptomatic phenomenon causing chronic, nonmalignant pelvic pain. In its simplest form, pudendal neuropathy causes perineal pain (pudendal neuralgia) that is aggravated by sitting or driving, reduced when standing, and relieved by sitting on a toilet seat. Despite repetitious complaints of pain and organ dysfunction, the diagnosis of neuropathic pain is delayed for years because evaluations and treatments are focused on suspected morphologic causes. Pudendal Nerve Entrapment Syndrome is a condition that can significantly impact daily life, causing chronic pain in the pelvic area.
This video will break down what PNE is, how it’s robotic surgery available, with a special focus on an innovative robotic surgical technique developed by Prof. Dr. Tibet Erdogru.
Clinical symptoms suggest that pudendal neuropathy is mainly a disorder of small, unmyelinated C fibers affecting both somatic and autonomic afferent and efferent nerves.
As mentioned before, causes of pudendal neuropathy include compression, stretch, direct trauma, and iatrogenic interventions such as pelvic surgeries (especially using with prolen mesh) and radiation. A common concern among patients is repetitive exaggerated flexion at the hip during running, cycling, exercising, and sports activities. Repetitive compression on the perineum while sitting on a bicycle seat exceeds by two-fold or three-fold pressure resulting in temporary neural ischemia.
Comparison with quadrupeds, the bipedal body shape of humans requirements a strong pelvic floor muscles and a well-developed ischial spine. With bipedal movements, traction by ligaments and fascias remodel the ischium, the ischial spine. Bony changes are consistently evident during pudendal blocks under fluoroscopic view. The remodeled ischial spine projects medially, superiorly, and posteriorly. The tip of spina can become broad and rounded bilaterally. Unilateral ischial spina remodeling occurs in equestrians and in athletes pushing off consistently with the same leg. Whilst ischial spina have sharp edges, the attached sacrospinous ligament broadens and rotates. The interligamentary space, between sacrospinous (SSL) and sacrotuberous (STL) ligaments, narrows and restricts nerve movement or causes compression. Sitting position compresses the nerve between the SSL and STL ligaments as “clamp”, probably causing ischemia. In addition, the ischioanal fat body may elevate the nerve against the falciform process of the sacrotuberous ligament.
Most surgical compressions (about 90%) are found between the STL and SSL ligaments (the interligamentous space). Multiple fascial bands may compress the nerve near the ischial spine. About 10% of compressions are observed in the pudendal (Alcock’s) canal.
Pudendal Nerve Entrapment Syndrome (PNES) is a complex and often underdiagnosed condition that significantly impacts quality of life. This detailed review examines the anatomy and pathophysiology of the pudendal nerve, the clinical presentation of pudendal neuralgia, diagnostic challenges, and the full spectrum of treatment options. A particularly innovative and effective surgical treatment—Robotic Surgery in Pudendal Neurolysis (also known as Robotic Pudendal Nerve Decompression Surgery)—has been pioneered by Prof. Dr. Tibet Erdogru.
Advantages include enhanced visualization, reduced blood loss, shorter hospital stays, and faster recovery, as detailed in Prof. Dr. Tibert Erdoğru’s Robotic Surgery Page. Prof. Dr. Tibert Erdoğru, a urologist with extensive experience, pioneered laparoscopic pudendal nerve decompression in 2014 and transitioned to robotic methods since 2021, His work includes case reports showing 90% pain reduction sustained at 10 weeks post-procedure.
Pudendal Nerve Entrapment Syndrome requires a multidisciplinary approach, with conservative treatments as the first line and robotic surgery as an effective option for non-responders. Prof. Dr. Erdoğru’s advancements in robotic pudendal neurolysis offer hope for improved outcomes, emphasizing precision and minimal invasiveness.
For those experiencing symptoms and seeking advanced treatment, contact Prof. Dr. Tibert Erdoğru’s clinic for a consultation to explore Robotic Pudendal Nerve Decompression Surgery. You can also follow the robotic pudendal nerve releasing videos