scholarly journals RETROGRADE EJACULATION FOLLOWING LUMBOPELVIC SYMPATHETIC NEUROLYSIS – A CASE SERIES

2017 ◽  
pp. 133-142
Author(s):  
Ajax Yang
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Case Series ◽  
Retrograde Ejaculation ◽  
Potential Consequence ◽  
Careful Evaluation ◽  
Hypogastric Plexus ◽  
Superior Hypogastric Plexus ◽  
Male Patients ◽  
Ganglion Impar

Background: Sympathetic neurolysis, or sympathectomy, is an established modality for the treatment of chronic pain. In cases of chronic pelvic pain (CPP), the ganglion of impar (GI) and the superior hypogastric plexus (SHP) are widely accepted targets for such therapy. Objective: While diagnostic injections typically predate any neurolysis for the purpose of ascertaining any potential effi cacy for interrupting a particular pathway, careful attention is equally paid to evaluate for possible adverse events - in the case of lumbopelvic neurolysis, retrograde ejaculation (RE) is one such possibility. Study Design: A case series. Setting: An outpatient pain management clinic. Methods: We present 3 male patients with CPP treated who underwent neurolytic procedures targeting the GI and SHP. Results: The fi rst patient developed RE after undergoing a simultaneous neurolysis of both the SHP and GI, in the same sitting. The second and third patients both experienced temporary RE immediately after diagnostic blockades of the SHP, following GI neurolysis that was performed several weeks prior. Limitations: Cause-effect conclusions cannot be drawn from the results of a case series. Conclusions: RE is a potential consequence of combined or serial SHP and GI neurolysis. While neurolysis of either the GI or SHP individually have not been known to cause RE in men, this case series demonstrates the potential risk in causing it when both structures are simultaneously incapacitated in some form; as such, the authors recommend against both structures being ablated or disabled concurrently without careful evaluation with temporary blockades fi rst. In an effort to avoid such a complication or evaluate for the possibility in a particular individual, we recommend that an individual with CPP, who has already been treated with a neurolysis, undergoes diagnostic blocks fi rst on whichever of the 2 structures has not yet been ablated to carefully evaluate if RE will occur. Key words: Retrograde ejaculation, superior hypogastric plexus, ganglion impar; neurolysis, chronic pelvic pain, male infertility, diagnostic block

Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer

Pain ◽  
1993 ◽  
Vol 54 (2) ◽  
pp. 145-151 ◽  
Author(s):  
Oscar A. de Leon-Casasola ◽  
Edward Kent ◽  
Mark J. Lema
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Hypogastric Plexus ◽  
Superior Hypogastric Plexus ◽  
Plexus Block

scholarly journals Superior Hypogastric Plexus Block for Chronic Pelvic Pain Through an S1 Transforaminal Approach: A Case Report

2019 ◽  
pp. 133-137
Author(s):  
Zahra Sykes
Keyword(s):  
Case Report ◽  
Pelvic Pain ◽  
Chronic Prostatitis ◽  
Chronic Pelvic Pain ◽  
Pelvic Surgery ◽  
Pelvic Pain Syndrome ◽  
Transforaminal Approach ◽  
Hypogastric Plexus ◽  
Superior Hypogastric Plexus ◽  
Plexus Block

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

scholarly journals Superior Hypogastric Plexus Combined with Ganglion Impar Neurolytic Blocks for Pelvic and/or Perineal Cancer Pain Relief

2015 ◽  
Vol 18;1 (1;1) ◽  
pp. E49-E56
Author(s):  
Doaa Gomaa Ahmed
Keyword(s):  
Cancer Pain ◽  
Pelvic Pain ◽  
Small Sample Size ◽  
Oral Morphine ◽  
Small Sample ◽  
Perineal Pain ◽  
Hypogastric Plexus ◽  
Superior Hypogastric Plexus ◽  
Neurolytic Block ◽  
Ganglion Impar

Background: The superior hypogastric plexus (SHGP) carries afferents from the viscera of the lower abdomen and pelvis. Neurolytic block of this plexus is used for reducing pain resulting from malignancy in these organs. The ganglion impar (GI) innervats the perineum, distal rectum, anus, distal urethra, vulva, and distal third of the vagina. Different approaches to the ganglion impar neurolysis have been described in the literature. Objectives: To assess the feasibility, safety, and efficacy of combining the block of the SHGP through the postero-median transdiscal approach with the GI block by the transsacro-coccygeal approach for relief of pelvic and/or perineal pain caused by pelvic and/or perineal malignancies or any cancer related causes. Methods: Fifteen patients who had cancer-related pelvic pain, perineal pain, or both received a combined SHGP neurolytic block through the postero-median transdiscal approach using a 20-gauge Chiba needle and injection of 10 mL of 10% phenol in saline plus a GI neurolytic block by the trans-sacro-coccygeal approach using a 22-gauge 5 cm needle and injection of 4 – 6 mL of 8% phenol in saline. Pain intensity (measured using a visual analogue scale) and oral morphine consumption pre- and post-procedure were measured. Results: All patients presented with cancer-related pelvic, perineal, or pelviperineal pain. Pain scores were reduced from a mean (± SD) of 7.87 ± 1.19 pre-procedurally to 2.40 ± 2.10 one week post-procedurally (P < 0.05). In addition, the mean consumption of morphine (delivered via 30 mg sustained-release morphine tablets) was reduced from 98.00 ± 34.89 mg to 32.00 ± 28.48 mg after one week (P < 0.05). No complications or serious side effects were encountered during or after the block. Limitations: This study is limited by its small sample size and non-randomized study. Conclusion: A combined neurolytic SHGP block with GI block is an effective and safe technique for reducing pain in cancer patients presented with pelvic and/or perineal pain. Also, a combined SHGP block through a posteromedian transdiscal approach with a GI block through a trans-sacrococcygeal approach may be considered more effective and easier to perform than the recently invented bilateral inferior hypogastric plexus neurolysis through a transsacral approach. Key words: Superior hypogastric plexus block, ganglion impar block, cancer pain, pelvic pain, perineal pain

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