Adrian Imre Kastler MD, MSc, Abstract Co-Author: Nothing to Disclose

Bruno Alfred Kastler MD, PhD, Presenter: Nothing to Disclose

To assess the outcome of patients with typical refractory pudendal neuralgia who underwent dual site CT guided pudendal nerve infiltration .

Between 1995 and 2014, 302 pudendal infiltrations were performed in 167 patients in our Unit. Only patients suffering from typical clinical pudendal neuralgia were included and only the first infiltration in each patient was considered for analysis. Therefore, 79 patients who underwent 129 procedures were assessed. Pain was assessed using Visual Analogue Scale scores (0-10) and self reported estimated improvement, expressed as a percentage. Efficacy of procedure was assessed at 1 month follow up and was defined as a 50% decrease of VAS score. Minimum follow up period was 6 months. All procedures were performed under CT Guidance and on an outpatient basis. Dual site infiltration was performed in each case at both ischial spine and Alcock’s canal sites using a mixture of fast and slow acting anesthetic (1 ml lidocaïne hydrochloride 1% and 2 ml ropivacaïne chlorhydrate) along with a half dose of 1.5 mL of cortivazol (3.75 mg).

Our cohort consisted of 79 patients (53 females (67,1%) 26 males (32.9%)) with a mean age of 53 years old (range 24-86). Mean pain prior procedure was 7.25/10. Patients suffered from bilateral pain in 50 cases and unilateral pain in 29 cases. Technical success of procedure was 100%. Mean procedure time was 10-15 minutes in case of unilateral infiltration and 20-25 minutes in cases of bilateral infiltration. Clinical success as defined at 1 month was 63 % of all performed procedures. Mean efficacy following procedure in cases of positive response was 3.3 months (ranging from 1 to 48 months). Mean self reported 1 month estimated improvement was 70% in patients with a positive response.  

CT guided dual site infiltration of the pudendal nerve is an effective treatment in patients suffering from chronic pudendal neuralgia.

Pudendal neuralgia is a debilitating condition with a high socio-economic impact. Treatments for this condition are sparse and pudendal neuralgia may become refractory. CT guided dual site infiltration presents satisfactory mid term results alleviating pain in these patients suffering from intractabe pain

Kastler, A, Kastler, B, CT Guided Dual Site Nerve Infiltration for Chronic Refractory Pudendal Nerve Neuralgia: Results of a Single Center in 79 Patients and 129 Procedures.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014103.html