Chronic prostatitis/chronic pelvic pain syndrome
(CPPS) is a debilitating syndrome commonly
seen in men under the age of 50 years, which
greatly impacts the quality of life. The treatment
is challenging, which often requires a multimodal
management approach. The superior hypogastric
plexus is located anterior to L5 and S1 vertebral
bodies in the retroperitoneal space and contains
afferent pain fibers from most of the pelvic
structures. Performing a superior hypogastric
plexus block (SHPB) can potentially alleviate
pain originating from various pelvic regions and
structures. It is currently a viable therapy for many
syndromes including endometriosis, interstitial
cystitis, irritable bowel syndrome, and pain after
pelvic surgery.
In this case report, we present a patient who had
chronic pelvic pain with a poor response to conservative
management. Initially, attempts at an
SHPB from the classic posterolateral approach
were unsuccessful. This technique for performing
this block can prove difficult due to vasculature
variability or anatomic barriers, such as the iliac
crest and transverse process of the fifth lumbar
vertebrae. Thus, a left S1 transforaminal approach
was used to block the plexus. This provided the
patient with one month of near 100% pain relief,
with gradual return to baseline thereafter.
CPPS poses unique treatment challenges.
Although often treated conservatively, SHPB
is a valid treatment option for those who fail to
respond adequately to other modalities. An S1
transforaminal approach is a novel and valuable
alternative technique for SHPB in patients with
compromising anatomy.
Key words: Chronic prostatitis, chronic pelvic
pain, superior hypogastric plexus, superior hypogastric
plexus block, pelvic trauma, pelvic pain
in men
Superior Hypogastric Plexus Block for Chronic Pelvic Pain Through
an S1 Transforaminal Approach: A Case Report