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Had urethroplasty surgery but in constant pain. Took to pain managnement, pills, injection. Is it pudendal nerve entrapment?

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I had successful urethroplasty surgery two months ago, but have been in constant pain since then. My surgeon and urologist think there is some type of "nerve involvement" and recommended me to a pain management center. After four doctors and and a physical therapist, and hundreds of dollars, I have tried ibufrofen, tylenol, hydrocodone, valium, gapabentin, nucynta, a pain cream containing bipuvacaine, clonidine, ketamine, and finally a local anesthetic injection of bipuvacaine. Only the injection provided instant relief, but only lasted two hours. My surgeon says the pain will eventually subside on its own in another 3 months, but I won't be able to stand it that long and don't know where else to turn. Am I suffering from pudendal nerve entrapment? I am a 54 year old male in good health, but I now wish I had never had that surgery two months ago to remove a stricture. My neurologist mentioned something called nerve freezing as a last resort, but admitted he did not have a lot of experience in that procedure. I've actually broken down in tears in two doctors offices already and getting very scared. Any advise you can give will be appreciated
Posted Mon, 18 Jun 2012 in Brain and Spine
Answered by Dr. Shiva Kumar R 25 hours later

Thank you for sending your question.

Your question is a good one and I will work on providing you with some information and recommendations regarding the problems you are experiencing.

From the clinical details provided to me it looks to me like you are suffering from entrapment of the pudendal nerve as a sequelae of surgery and radiation therapy. From the description it looks like you have terrible pain with temporary relief with local anesthetic injection.

I feel as you had some relief with Bupivacaine, trying a combination of long-acting local anesthetic (bupivacaine) and a corticosteroid ( methylprednisolone) would be of some benefit to you. If you do not respond a trial of Botox injection would be an option before we could consider decompressive surgery in you.

My recommendation would be for you to try these modalities of treatment before we consider surgery to release the nerve in you. In view of radiation and surgery in the past, pelvic floor adhesion's would have occurred and caused nerve compression. Do continue on Gabapentin along with Pregabalin and other pain medicines.

I thank you again for submitting your question. I hope you find my response to be both helpful and adequate.

If you have any additional concerns regarding your question I would be happy to address them.


Dr Shiva Kumar R
Consultant Neurologist & Epileptologist.
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