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

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.

Download Full-text

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

PM&R ◽

10.1016/j.pmrj.2013.08.548 ◽

2013 ◽

Vol 5 ◽

pp. S301-S302

Author(s):

Christopher Bui ◽

Sanjog Pangarkar ◽

Scott I. Zeitlin

Keyword(s):

Radiofrequency Ablation ◽

Pelvic Pain ◽

Pudendal Nerve ◽

Urinary Urgency ◽

Case Presentation ◽

Pulse Radiofrequency

Download Full-text

865 CAT SCAN‐GUIDED PUDENDAL NERVE BLOCK IN THE DIFFERENTIAL DIAGNOSIS OF PELVIC PAIN. TREATMENT IMPLICATIONS

European Journal of Pain ◽

10.1016/s1090-3801(09)60868-5 ◽

2009 ◽

Vol 13 (S1) ◽

Cited By ~ 1

Author(s):

O. Calvillo ◽

P. Sovelius ◽

I. Skaribas

Keyword(s):

Differential Diagnosis ◽

Nerve Block ◽

Pelvic Pain ◽

Pudendal Nerve ◽

Pain Treatment ◽

Pudendal Nerve Block ◽

Cat Scan

Download Full-text

Pudendal Nerve Block vs Penile Nerve Block for Analgesia During Pediatric Circumcision

Case Medical Research ◽

10.31525/ct1-nct03914365 ◽

2019 ◽

Author(s):

Keyword(s):

Nerve Block ◽

Pudendal Nerve ◽

Pudendal Nerve Block

Download Full-text

Abstract No. 580 Initial experience of CT-guided pulsed radiofrequency ablation of the pudendal nerve for chronic recalcitrant pelvic pain

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2018.01.625 ◽

2018 ◽

Vol 29 (4) ◽

pp. S242 ◽

Cited By ~ 1

Author(s):

M. Collard ◽

X. Yin ◽

A. Patel ◽

K. Scott ◽

A. Chhabra

Keyword(s):

Radiofrequency Ablation ◽

Pelvic Pain ◽

Pudendal Nerve ◽

Initial Experience ◽

Pulsed Radiofrequency ◽

Ct Guided

Download Full-text

Pulsed Radiofrequency Ablation of Pudendal Nerve for Treatment of a Case of Refractory Pelvic Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2017.e454 ◽

2017 ◽

Vol 3 (20;3) ◽

pp. E451-E454 ◽

Cited By ~ 1

Author(s):

Stephanie Jones

Keyword(s):

Radiofrequency Ablation ◽

Pain Relief ◽

Pelvic Pain ◽

Pudendal Nerve ◽

Pudendal Neuropathy ◽

Ischial Spine ◽

Pulsed Radiofrequency ◽

Pudendal Neuralgia ◽

Mr Neurography ◽

The Right

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

Download Full-text

Pudendal Nerve Block in Male Goats: Comparison of Ischiorectal Fossa and Ischial Arch Approaches Using Low Volume 1% Lignocaine Hydrochloride

Macedonian Veterinary Review ◽

10.1515/macvetrev-2015-0064 ◽

2016 ◽

Vol 39 (1) ◽

pp. 111-115 ◽

Cited By ~ 1

Author(s):

Mujeebur Rehman Fazili ◽

Nida Handoo ◽

Mohd Younus Mir ◽

Beenish Qureshi

Keyword(s):

Nerve Block ◽

Local Anaesthetic ◽

Pudendal Nerve ◽

Rectal Wall ◽

Ischiorectal Fossa ◽

Pudendal Nerve Block ◽

Short Term Exposure ◽

Group 2 ◽

Manual Manipulation ◽

Group 1

AbstractThirty (30) adult male goats were injected xylazine (0.05 mg/kg, IM) and randomly divided into three equal groups. Internal pudendal nerve block was tried using 3.5 ml (on each side) of 1% lignocaine hydrochloride byischiorectal fossa or ischial arch approaches in goats from Group 1 and Group 2 respectively, 15 minutes after giving xylazine. Inadvertent puncture of the rectal wall and prick to the finger placed in the rectum was experienced once in Group 1 animal. None of the animals showed protrusion of the penis without manual manipulation. Prolapse of the prepucial ring was noticed in three animals from Group 1 and two each from Group 2 and 3. The application of mild manual push percutaneously resulted in the exposure of the penis in eight and six animals belonging to Group 1 and Group 2 respectively, 15 minutes after injection of the local anaesthetic. Statistically significant (P>0.05) difference between Group 1 and 2 values was detected only once at 90 minutes following injection of the local anaesthetic. The block lasted longer in animals of Group 1. The exposed organ was flaccid and insensitive. The organ retracted into the prepucial cover within five minutes of its release in all the animals. The penile exposure could not be achieved by similar manipulation in any of the Group 3 animals. From this study it was concluded that the ischiorectal fossa approach is cumbersome and may lead to inadvertent punctures, but the block develops in more number of animals for a longer period than with the ischial arch approach. The outcome of the two techniques did not show statistically significant (P>0.05) difference for most of the assessment period. Reducing the concentration of lignocaine hydrochloride may reduce the chances of continued relaxation of the penis beyond the required period and also the drug toxicity. However, studies using larger volume of 1% lignocaine hydrochloride may be undertaken for short term exposure of the penis without manual manipulation.

Download Full-text