Therapeutic Efficacy of Ultrasound-Guided High-Voltage Long-Duration Pulsed Radiofrequency for Pudendal Neuralgia.

Feng Ji,Hua Xu,Shuzhuan Zhou,Caixia Li,Yongyan Zhang,Xu-Yun Hua

doi:10.1155/2021/9961145

Abstract

Pudendal neuralgia (PN) is a complex disease with various clinical characteristics, and there is no treatment showing definite effectiveness. This study is aimed at evaluating the clinical efficacy of ultrasound-guided high-voltage long-duration pulsed radiofrequency (PRF) for PN. Two cadavers (one male, one female) were dissected to provide evidence for localization of the pudendal nerve. Patients diagnosed as PN who failed or were intolerant in regular medication were screened for diagnostic local anesthesia block of the pudendal nerve before recruitment. Twenty PN patients were enrolled in this study. In the PRF procedure, the needle tip was inserted medially into the internal pudendal artery under ultrasound guidance. The position of the PRF needle tip was then adjusted by the response of the pudendal nerve to the electrical stimulation within the pudendal area (42°C, a series of 2 Hz, and 20 ms width pulses that lasted for 900 s). Alleviation of pain was assessed by the visual analogue scale (VAS) and sitting time pretreatment and on 7 d, 14 d, 1 m, 2 m, 3 m, and 6 m posttreatment in outpatient follow-up or by telephone interview. Two patients were lost due to intervention-irrelevant reasons. Patients showed significantly decreased VAS scores on 7 d after RFP, compared with pretreatment status (7.0 ± 0.9 vs. 3.2 ± 1.7, P < 0.001). The efficacy remained steady till the end of 6 months, with a final remission rate of 88.9%. Sitting time also significantly lengthened following PRF (7 d, 14 d, 1 m, 2 m, 3 m, and 6 m vs. pretreatment, all P < 0.05). Only short-term ipsilateral involuntary convulsion of the lower extremity was reported in one patient, who recovered within 12 h. Six patients were treated with nonsteroidal drugs for a short time. All patients stopped taking medication finally. In conclusion, the ultrasound-guided high-voltage long-duration PRF approach not only reduced the pelvic pain caused by PN but also improved the quality of life by extending sitting time without nerve injury.

Highlights

Pudendal neuralgia (PN) refers to neuropathic pain in the pudendal nerve innervation region, which may occur in the entire perineal region or in one of its branches, and is often accompanied by symptoms such as rectal and anal foreign body sensation, distension, frequency and urgency of urination, and sexual dysfunction [1, 2]
PN patients present a variety of clinical symptoms and usually need multidisciplinary treatment
The pathological changes of the pudendal nerve may lead to PN, such as herpes zoster neuralgia and diabetic peripheral neuralgia

Summary

Introduction

Pudendal neuralgia (PN) refers to neuropathic pain in the pudendal nerve innervation region, which may occur in the entire perineal region or in one of its branches, and is often accompanied by symptoms such as rectal and anal foreign body sensation, distension, frequency and urgency of urination, and sexual dysfunction [1, 2]. According to the survey by the International Pudendal Neuropathy Association, the incidence of PN in the general population is about 1/100,000 [3]. Spinosa et al [4] documented the incidence at 1% in the general population, which is higher in females than in males, with more unilateral cases [3]. PN patients present a variety of clinical symptoms and usually need multidisciplinary treatment. Due to the pain in private parts, patients tend to have a longer course of disease and more severe symptoms before willing to visit the doctor, which would seriously affect their quality of life. There is still a lack of definite treatment because of its unclear pathogenesis

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