QC: How Often Does Endometriosis Contribute to Nerve and Vascular Compression?

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0:00

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Dr. Bobelson's Expertise

Speaker 1
0:41

Today

we're

joined

by

expert

excision

specialist
,

dr

Nick

Fogelson
,

who

is

a

leading

surgeon

specializing

in

advanced

endometriosis

care
,

managing

complex

cases

involving

the

bowel
,

urinary

tract

and

thoracic

disease
.

One

of

the

few

in

the

US

with

formal

training

in

neuropelviology
,

he

brings

a

deep

neurological

understanding

of

pain

and

innovative

approaches

to

treatment
.

He

helps

us

navigate

some

of

the

complex

Nerve Compression and Endometriosis

Speaker 1
1:14

questions
.

Let's

get

started
.

How

often

do

you

see

nerve

and

vascular

compression

associated

with

endometriosis
,

and

is

it

always

associated

with

endometriosis
,

or

is

the

endometriosis

on

the

nerve
?

Specifically
,

how

many

of

your

cases

do

you

see

of

that
,

where

the

endometriosis

is

on

the

actual

nerve
?

Speaker 2
1:29

Well
,

I

mean

to

start

out

with
.

There's

going

to

be

a

tremendous

selection

bias

in

that

answer

because

those

patients

come

to

me
.

Speaker 1
1:35

Right
,

so

how

often

do

I
?

Speaker 2
1:37

see
,

it

is

not

necessarily

a

representative

of

how

common

it

is

in

the

universe
.

Speaker 2
1:41

It

is

not

that

common
.

I

would

say

that

it

is

frequent

that

there

is

endometriosis

in

locations

that

I

think

anatomically

is

probably

irritating

nerves
.

I

mean

all

endometriosis

pain

is

nerve

irritation

in

one

way

or

another
.

I

mean

all

pain

How Endo Irritates Nerves

Speaker 2
1:55

is

nerve

irritation

in

one

way

or

another
,

whether

it's

endometriosis

pain

or

any

kind

of

pain

like

you've

got

to

be

irritating

a

nerve

to

cause

pain
.

There's

plenty

of

people

that

have

endometriosis

in

common

locations

where

people

have

endo
,

where

anatomically

it

makes

sense

what

their

symptoms

are
.

For

someone

that

has

a

dull
,

aching

pain

radiating

to

their

back
,

that

is

cyclic
,

and

then

they

have

endometriosis

in

their

uterus

sacral

ligaments
.

It's

not

necessarily

directly

invading

nerves

but

it

makes

all

the

sense

in

the

world

because

the

hypogastric

nerve

plexus

is

like

half

a

centimeter

underneath

those

lesions

and

so

it's

going

to

cause

enough

inflammation

that

those

nerves

are

going

to

be

irritated
.

And

if

you

irritate

the

hypogastric

nerve

plexus

you're

going

to

get

dull
,

aching

pain

radiating

into

your

back
.

You're

going

to

get

potentially

voiding

dysfunction
.

You

can

get

failure

to

empty

your

bladder
,

you

can

get

urgency

to

urinate
,

you

can

get

a

variety
,

and

then

you

can

have

bowel

dysfunction

too
,

or

you

can

have

intermittent

constipation

and

diarrhea

and

dyskinesia
,

which

is

painful

bowel

movements
.

All

of

that

can

come

from

a

lesion

that

isn't

necessarily

invading

a

nerve

but

it's

close

enough

to

be

inflaming

the

nerves
.

Speaker 2
2:58

And

then

there

are

some

cases

that

literally

are

invading

nerves

and

they're

not

that

common
.

There's

a

subset

of

them

where

there

is

endometriosis

Skip Lesions and Neuropelviology

Speaker 2
3:08

in

the

pelvis
.

That's

just

really

bad

and

it's

extending

out

wide

enough

that

it

has

gotten

kind

of

onto

the

nerves
.

And

then

there's

another

subset

where

they

literally

have

what

I

would

call

skip

lesions
,

where

the

pelvis

doesn't

look

too

bad

but

if

you

dissect

all

the

way

down

to

the

nerve

you'll

find

a

lesion

right

on

the

nerve

that

was

not

contiguous

with

lesions

in

the

pelvis
.

And

those

are

the

ones

that

are

going

to

be

really

hard

to

ever

find

without

neuropelviology

thoughtfulness
,

because

it

is

the

history

of

the

patient

that

tells

you

that

the

lesion

is

there
,

by

the

patient

giving

you

a

history

and

maybe

a

physical

exam

that

leads

you

to

suspect

a

lesion

on

a

particular

nerve
.

And

then

you

operate

and

you

don't

see

anything

in

the

pelvis

that

would

be

extending

into

that

area
.

But

you

go

down

and

dissect

out

that

nerve

anyway

and

you

find

the

lesion

on

the

nerve
.

That

is

something

that

without

neuropelvulology

training

you're

probably

never

going

to

solve
,

because

nobody's

going

and

making

a

cadaver

dissection

out

of

pelvic

nerve

roots

for

no

reason
,

and

so

you

better

have

a

really

good

reason

to

be

doing

it
,

because

you

could

injure

the

patient

if

you're

not

technically

good

at

what

you're

doing
.

Speaker 2
4:11

And

also

those

areas

are

very

vascular
.

Speaker 2
4:13

There's

big

vessels

down

there

and

if

you're

not

very

careful

you

can

get

into

a

concerning

amount

of

bleeding
,

and

so

those

kinds

of

things

are

rare
,

but

they

do

come

up

and

to

some

extent

they're

more

often

when

you're

really

paying

attention

to

them
.

I

see

them

a

fair

bit
,

partially

because

they

come

to

me
,

but

also

I

think

I

make

diagnoses

that

sometimes

other

people

wouldn't

make
,

because

I

think

I'm

thinking

about

it

a

little

bit

differently
,

and

it

leads

one

to

sometimes

pick

up

on

things
.

Sometimes

the

patient

tells

you

a

story

that

really

leads

to

think

of

a

very

specific

lesion

in

a

very

specific

location
,

and

sometimes

you'll

operate

and

don't

see

anything

in

the

pelvis

that

you

think

is

going

to

extend

into

that

area
,

and

yet

so

then

you

just

dissect

into

that

area

specifically

and

indeed

find

something
,

and

a

lot

of

times

those

cases

are

vascular
.

You

know

where

there's

going

to

be

like

a

little

tight

band

of

vein

around

there

where

she

never

wasn't

endometriosis
,

so

there

was

no

reason

for

it

to

be

extending

from

anything
.

Speaker 2
5:04

But
,

she

never

was

endometriosis
,

so

there

was

no

reason

for

it

to

be

extending

from

anything
.

But

indeed

there

is

a

lesion

somewhere

that

is

anatomical
.

Episode Closing and Contact Info

Speaker 1
5:10

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a

wrap

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.

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