Promoting Earlier Diagnosis and Effective Treatment for Pelvic Pain
Hackensack University Medical Center’s urogynecology and pelvic reconstructive surgery experts are at the forefront of treating pelvic pain. They emphasize the importance of early diagnosis and employ robotic surgical nerve stripping techniques for minimally invasive treatment of inflammation and pressure that cause nerve damage.
Khashayar Shakiba, M.D., division director of Urogynecology and Pelvic Reconstructive Surgery at Hackensack University Medical Center, explained that 10 percent of women live with chronic pelvic pain, often due to inflammation from endometriosis or other conditions that progressively damage nerves. This pelvic neuro-inflammation causes nerve hyper-excitation, leading to pelvic floor dysfunction. Additionally, persistent abnormal signals to the brain can result in centralization, presenting with persistent fatigue, nausea, brain fog, palpitations, and more.
Dr. Shakiba highlighted that these abnormal signals can also cause urinary and bowel problems, bloating, infertility, painful menstruation, sexual dysfunction, pelvic pressure and discomfort, and fertility issues. Robotic surgical technology enables surgeons to access nerves causing these symptoms, which may be located deep within the buttocks, pelvis, or other challenging-to-reach areas.
A three-pronged approach to endometriosis care
For conditions like endometriosis, one of the leading causes of pelvic neuro-inflammation, a three-pronged strategy is applied: early detection, optimal surgical removal of the active insults to pelvic nerves, and continuous monitoring after surgery to reduce recurrence.
Dr. Shakiba and his team are actively working to expedite the diagnosis of pelvic pain in women. They have developed a free app that serves as a diagnostic tool for endometriosis and includes symptom and medication trackers, educational resources, and tools that assist in monitoring the effectiveness of treatment.
Dr. Shakiba highlighted the significant delay in receiving an accurate diagnosis for endometriosis and pelvic pain, which can take an average of 7-11 years. He emphasized the importance of providing women with an earlier diagnosis and connecting them to the necessary care to alleviate their symptoms and improve their quality of life.
Robotic surgery optimizes treatment of pelvic nerve irritation
When the diagnosis of endometriosis is highly suspected and the patient’s symptoms and pain are severe, surgery may be considered as the next step. Optimal surgery involves not only the complete resection of active endometriosis but also the removal of active insults on various pelvic nerves to eliminate the source of nerve irritation and reverse the cycle of nerve hyper-excitements that contribute to the symptoms.
Dr. Shakiba explained that the advanced robotic-assisted technology at Hackensack University Medical Center allows for precise removal of active insults from various pelvic nerves, such as the hypogastric, obturator, pudendal and sciatic nerves, with minimal surgical damage to already affected nerves. The robotic magnified and stable vision, coupled with intuitive instrumental assistance, significantly enhances the surgical precision when dealing with delicate structures like pelvic nerves.
Dr. Shakiba emphasized the superiority of robotic surgery in cases of pudendal neuralgia and pudendal nerve entrapment compared to traditional trans-gluteal and non-robotic approaches. He has successfully performed hundreds of robotic-assisted pudendal nerve decompression surgeries, positioning Hackensack University Medical Center as one of the world’s leading hospitals for the management of pudendal neuralgia.
Dr. Shakiba also performed the first-ever robotic decompression of the pudendal nerve from within the Alcock canal in 2021.
The traditional trans-gluteal approach is considerably more aggressive and results in greater postoperative pain. However, it fails to address the underlying cause of pain, which is prevalent in patients with pudendal neuralgia.
“By utilizing the robotic technique with access to the Alcock canal, we achieve a more effective decompression effect, minimize surrounding damage, and, most importantly, we can eliminate other pain sources since we thoroughly inspect the entire pelvic area. Our research indicates that nearly 80 percent of our patients experience complete resolution or significant improvement in pain and other symptoms following pudendal nerve surgical treatment,” said Dr. Shakiba.
Click here for more information on Hackensack Meridian Health’s Gynecology program.