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J Reconstr Microsurg 2014; 30(08): 547-550
DOI: 10.1055/s-0033-1361844
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Chronic Pelvic Pain after Laser Prostatectomy: Treatment by Resection of the Perineal Branches of the Pudendal Nerve

A. Lee Dellon
1   Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland
2   Departmemt of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
,
E. James Wright
3   Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Paul N. Manson
1   Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

15 September 2013

17 September 2013

Publication Date:
17 February 2014 (online)

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Abstract

Development of chronic pelvic pain after laser resection for benign prostatic hypertrophy has not been described previously (Clavien IIIb complication). The etiology of this chronic pain, which persisted despite medical chronic pain and urologic management for 5 years, was proven to be of pudendal nerve origin by local anesthetic blockade of the pudendal nerves bilaterally at the ischial spines. Surgical treatment was based upon the anatomic proximity of the perineal and dorsal branches of the pudendal nerve to the site of laser therapy on the pelvic side of the urogenital diaphragm. Treatment required resection of the perineal branches of the pudendal nerve bilaterally and neurolysis of the dorsal nerve to the penis bilaterally through incisions overlying the inferior pubic ramus. Relief of perineal pain and pain with micturition occurred in the immediate postoperative period. Pain relief and resumption of all normal activity occurred by 3 months postoperatively and continues 13 months following the surgery.

Keywords

prostatectomy - pudendal nerve - laser
 

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