Initial experience of CT-guided pulsed radiofrequency ablation of the pudendal nerve for chronic recalcitrant pelvic pain

Pudendal neuralgia (PN) is a result of pudendal nerve entrapment or injury, also called “Alcock syndrome.” Pain that develops is often chronic, and at times debilitating. If conservative measures fail, invasive treatment modalities can be considered. The goal of this case report is to add to a small body of literature that a pulsed radiofrequency (PRF) ablation can be effectively used to treat PN and to show that high resolution MR neurography imaging can be used to detect pudendal neuropathy. Case Presentation: We present a case of a 51-year-old woman with 5 years of worsening right groin and vulva pain. Various medication trials only lead to limited improvement in pain. The first diagnostic right pudendal nerve block was done using 3 mL of 0.25% bupivacaine with 6mg of betamethasone using a transgluteal technique and a target of the right ischial spine; this procedure resulted in ~8 hours of > 50% pain relief. The patient was then referred for MR neurography of the lumbosacral plexus. This study revealed increased signal of the right pudendal nerve at the ischial spine and in the pudendal canal, findings consistent with the clinical picture of PN. Six weeks after the initial block, the patient underwent a second right transgluteal pudendal nerve block, utilizing 3 mL of 0.25% bupivacaine with 40 mg of triamcinolone acetonide; this procedure resulted in ~8 hours of 100% pain relief. Satisfied with these results the patient decided to undergo pudendal nerve PRF ablation for possible long-term relief. For this therapeutic procedure, a right transgluteal approach was again utilized. PRF ablation was performed for 240 seconds at 42° Celsius. Following this ablation the patient reported at least 6 weeks of significant (> 50%) pain relief. Discussion and Conclusion: In this paper we presented a case of successful treatment of PN with PRF ablation and detection of pudendal neuropathy on MR neurography. We believe that transgluteal PRF ablation for PN might be an effective, minimally invasive option for those patients that have failed conservative management. MR neurography employed in this case is not only helpful in confirming the diagnosis of PN but could also be useful in ruling out other causes of pelvic pain, such as genitofemoral neuropathy, endometriosis, adenomyosis, or pelvic mass lesion. To conclude, transgluteal PRF ablation can serve as a viable treatment option for mitigating symptoms of pudendal neuropathy and MR neurography is useful in confirming a clinically suspected diagnosis of PN. Key words: Pelvic pain, pudendal neuralgia, MR neurography, pulsed radiofrequency ablation, transgluteal technique, Alcock canal syndrome

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Thoracic Tumors Treated With CT-guided Radiofrequency Ablation: Initial Experience

Yearbook of Oncology ◽

10.1016/s1040-1741(08)70148-9 ◽

2006 ◽

Vol 2006 ◽

pp. 209-212

Author(s):

E. Glatstein

Keyword(s):

Radiofrequency Ablation ◽

Initial Experience ◽

Ct Guided

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Percutaneous CT-Guided Cryoablation of the Bilateral Pudendal Nerves for Palliation of Intractable Pain Related to Pelvic Neoplasms

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119892003 ◽

2020 ◽

Vol 37 (8) ◽

pp. 619-623 ◽

Cited By ~ 2

Author(s):

John David Prologo ◽

Sivasai Manyapu ◽

Zachary L. Bercu ◽

Ashmit Mittal ◽

Jason W. Mitchell

Keyword(s):

Computed Tomography ◽

Pelvic Pain ◽

Pudendal Nerve ◽

Intractable Pain ◽

Pelvic Neoplasms ◽

Ct Guided ◽

Patient Demographics ◽

Pain Scores ◽

The Mean ◽

Mean Time

Objectives: The purpose of this report is to describe the effect of computed tomography–guided bilateral pudendal nerve cryoablations on pain and time to discharge in the setting of acute hospitalizations secondary to refractory pelvic pain from cancer. Methods: Investigators queried the medical record for patients who underwent pudendal nerve cryoablation using the Category III Current Procedural Technology code assignment 0442T or Category I code 64640 for cases prior to 2015. The resulting list was reviewed, and procedures performed on inpatients for intractable pelvic pain related to neoplasm were selected. The final cohort was then analyzed with regard to patient demographics, procedure details, technical success, safety, pain scores, and time to discharge. Results: Ten patients underwent cryoablation by 3 operators for palliation of painful pelvic neoplasms between June 2014 and January 2019. All probes were satisfactorily positioned and freeze cycles undertaken without difficulty. There were no procedure-related complications or adverse events. The mean difference in pre- and posttreatment worst pain scores was significant (n = 5.20, P = .003). The mean time to discharge following the procedure was 2.3 days. Conclusion: Computed tomography–guided percutaneous cryoablation of the bilateral pudendal nerves may represent a viable option in the setting of acute hospitalization secondary to intractable pain in patients with pelvic neoplasms.

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Poster 420 Pudendal Nerve Radiofrequency Ablation for Treatment of Atypical Pelvic Pain: A Case Report

PM&R ◽

10.1016/j.pmrj.2012.09.1030 ◽

2012 ◽

Vol 4 ◽

pp. S334-S334

Author(s):

Wes Wiltse ◽

Ake Evans ◽

Jeremiah Ladd ◽

Francis P. Lagattuta ◽

David C. Majors ◽

...

Keyword(s):

Case Report ◽

Radiofrequency Ablation ◽

Pelvic Pain ◽

Pudendal Nerve

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Role of 3 Tesla MR Neurography and CT-guided Injections for Pudendal Neuralgia: Analysis of Pain Response

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.e333 ◽

2019 ◽

Vol 4 (22;4) ◽

pp. E333-E344

Author(s):

Avneesh Chhabra

Keyword(s):

Study Design ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Pudendal Nerve ◽

Pain Response ◽

Pudendal Neuropathy ◽

Pudendal Neuralgia ◽

Ct Guided ◽

Perineural Injection

Background: Magnetic resonance neurography (MRN) has an increasing role in the diagnosis and management of pudendal neuralgia, a neurogenic cause of chronic pelvic pain. Objective: The objective of this research was to determine the role of MRN in predicting improved pain outcomes following computed tomography (CT)-guided perineural injections in patients with pudendal neuralgia. Study Design: This study used a retrospective cross-sectional study design. Setting: The research was conducted at a large academic hospital. Methods: Patients: Ninety-one patients (139 injections) who received MRN and CT-guided pudendal blocks were analyzed. Intervention: A 3Tesla (T) scanner was used to evaluate the lumbosacral plexus for pudendal neuropathy. Prior to receiving a CT-guided pudendal perineural injection, patients were given pain logs and asked to record pain on a visual analog scale. Measurement: MRN findings for pudendal neuropathy were compared to the results of the CTguided pudendal nerve blocks. Injection pain responses were categorized into 3 groups – positive block, possible positive block, and negative block. Statistical Tests: A chi-square test was used to test any association, and a Cochran-Armitage trend test was used to test any trend. Significance level was set at .05. All analyses were done in SAS Version 9.4 (SAS Institute, Inc., Cary, NC). Results: Ninety-one patients (139 injections) who received MRN were analyzed. Of these 139 injections, 41 were considered positive (29.5%), 52 of 139 were possible positives (37.4%), and 46 of 139 were negative blocks (33.1%). Of the patients who had a positive pudendal block, no significant difference was found between the MRN result and the pudendal perineural injection response (P = .57). Women had better overall response to pudendal blocks, but this response was not associated with MRN findings (P = .34). However, positive MRN results were associated with better pain response in men (P = .005). Patients who reported bowel dysfunction also had a better response to pudendal perineural injection (P = .02). Limitations: Some limitations include subjectivity of pain reporting, reporting consistency, absence of a control group, and the retrospective nature of the chart review. Conclusion: Pudendal perineural injections improve pain in patients with pudendal neuralgia and positive MRN results are associated with better response in men. Key words: MRI, MRN, CT injection, pudendal neuralgia, pudendal nerve, pelvic pain, chronic pelvic pain, pudendal neuropathy

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Prolonged relief of chronic pelvic pain by pulsed radiofrequency ablation of superior hypogastric plexus performed under ultrasound guidance: A case report

Indian Journal of Anaesthesia ◽

10.4103/ija.ija_493_20 ◽

2020 ◽

Vol 64 (9) ◽

pp. 816

Author(s):

Jyotsna Punj ◽

Mesha Srivastava

Keyword(s):

Case Report ◽

Radiofrequency Ablation ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Ultrasound Guidance ◽

Pulsed Radiofrequency ◽

Hypogastric Plexus ◽

Superior Hypogastric Plexus

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Relief of Urinary Urgency, Hesitancy, and Male Pelvic Pain with Pulse Radiofrequency Ablation of the Pudendal Nerve: A Case Presentation

Case Reports in Urology ◽

10.1155/2013/125703 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Christopher Bui ◽

Sanjog Pangarkar ◽

Scott I. Zeitlin

Keyword(s):

Radiofrequency Ablation ◽

Nerve Block ◽

Pelvic Pain ◽

Pudendal Nerve ◽

Urinary Urgency ◽

Case Presentation ◽

Pudendal Nerve Block ◽

Therapeutic Value ◽

Patient Reported ◽

History Of

Background and Aims. This report demonstrates the utility of a pudendal nerve block by pulsed radiofrequency ablation (RFA) for the treatment of male pelvic pain and urinary urgency and hesitancy.Methods. The patient is an 86-year-old gentleman with a 30-year history of urinary hesitancy and urgency. The patient also had pain in the area of the perineum but considered it a secondary issue. The patient was seen by a number of specialists, tried various medications, and underwent a variety of procedures to no avail. Therefore, the patient underwent a pulsed RFA of the pudendal nerve.Results. The patient underwent a pulsed RFA of the pudendal nerve; the patient reported marked improvement in his pelvic pain as well as a drastic reduction in his urinary urgency and hesitancy.Conclusion. Urinary urgency and hesitancy and male pelvic pain are some of the most common symptoms affecting men. Pudendal nerve block by pulsed RFA is an effective treatment of pelvic pain. It may also hold some therapeutic value in the treatment of urinary urgency and hesitancy as our case demonstrated. Further studies are needed to help clarify both the anatomy of the pelvis as well as if pudendal blocks are effective in treating more than pelvic pain.

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