• M D Collard, Y Xi, A A Patel, K M Scott, S Jones, and A Chhabra.
• Radiology Department, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA.
• Clin Radiol. 2019 Nov 1; 74 (11): 897.e17-897.e23.

AimTo evaluate initial experience with computed tomography (CT)-guided pulsed radiofrequency ablation (pRFA) of the pudendal nerve in cases of recalcitrant neuropathic pelvic pain. Endpoints include technical feasibility, safety, and efficacy of therapy.Materials And MethodsTen patients who underwent pRFA ablation for neuropathic pudendal nerve pain during the trial period were followed for response to treatment for 6 months. Each patient was treated with pRFA under CT-guidance with concurrent perineural injection of anaesthetic and/or corticosteroid. Pain scores were then measured using a numeric rating scale at fixed intervals up to 6 months.ResultsAll procedures were considered technically successful with no immediate complications. pRFA demonstrated improved duration of pain improvement compared to the most recent perineural injection (p=0.0195), but not compared to the initial injection (p=0.64). Reported pain scores were lower with pRFA than with both the first and most recent injection but this did not reach statistical significance (p=0.1094 and p=0.7539, respectively).ConclusionOverall, pRFA of the pudendal nerve using CT-guidance can be a safe and effective therapy. This technique provides direct visualisation of the nerve to maximise safety and efficacy while offering a novel form of therapy for patients with chronic, recalcitrant pelvic pain.Copyright © 2019 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

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