Had Urethroplasty Surgery But In Constant Pain. Took To Pain Managnement, Pills, Injection. Is It Pudendal Nerve Entrapment?
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.
Sincerely,
Dr Shiva Kumar R
Consultant Neurologist & Epileptologist.