Farklı Etiyolojilere Sahip Kronik Pelvik Ağrı Tedavisinde Ultrason KılavuzluğundaPudendal Sinirin Pulsed Radyofrekansı: Bir Olgu Serisi

Farklı etiyolojilere sahip kronik pelvik ağrı (KPA) tedavisinde, pudendal sinir (PS) bloğu ile birlikte uygulanan pulsed radyofrekans tedavisinin (PRT) etkinliğini değerlendirmeyi amaçladık. Kronik pelvik ağrısı farmakolojik tedavi ile azalmayan ve ultrason kılavuzluğunda bilateral PS’ye lokal anestezik ile kombine PRT uygulanan dokuz hastanın verileri retrospektif olarak incelendi. Yaş, cinsiyet, KPA etiyolojisi ve ağrı süresi kaydedildi. Tedaviye yanıt, PRT’den önce ve üç ay sonra Sayısal Derecelendirme Ölçeği (NRS) puanı ve Amerikan Ulusal Sağlık Enstitüleri Kronik Prostatit Semptom İndeksi (NIH-CPSI) ile değerlendirildi. Dokuz hastanın ortanca yaşı 56 olup, altısı erkekti. Tüm hastalar, medyan 12 aylık bir süre boyunca farklı etiyolojilere bağlı KPA’dan şikayetçiydi. Üç hastada interstisyel sistit, iki hastada mesane kanseri, diğer iki hastada prostatit ve son iki hastada pudendal nevralji vardı. Medyan NRS skorlarında PRT öncesine göre PRT sonrasında anlamlı bir düşüş vardı (9 kıyasla 3, p=0,017). Ayrıca, PRT öncesi ve sonrası NIH-CPSI değerlerinde de istatistiksel olarak anlamlı bir fark bulundu. Etiyolojisi mesane kanseri olan ikinci ve dördüncü olguların PRT öncesi ve sonrası skorları arasında belirlenen skorlama değerlerinde değişiklik olmadı. Pudendal sinir bloğu ile birlikte uygulanan PRT, ağrı şiddeti ve idrara çıkma şikayetlerinde azalma sağlamakta ve KPA’lı hastaların yaşam kalitesini artırmaktadır.

Ultrasound-Guided Pulsed Radiofrequency of the Pudendal Nerve for the Treatment of Chronic Pelvic Pain with Different Etiologies: A Case Series

We aimed to evaluate the efficacy of pulsed radiofrequency therapy (PRT) combined with pudendal nerve (PN) block for the treatment of chronic pelvic pain (CPP) with different etiologies. The data of nine patients whose CPP did not reduce with pharmacological treatment and who underwent PRT combined with a local anesthetic to the bilateral PN with ultrasound guided were analyzed retrospectively. Age, gender, CPP etiology, and duration of pain were evaluated. Response to treatment was assessed before and three months after the PRT by the Numerical Rating Scale (NRS) score and the American National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). The median age of the nine patients was 56 years, and six were male. All the patients had been complaining of a variety of CPP etiologies for a median duration of 12 months. Three patients had interstitial cystitis, two had urinary bladder carcinoma, another two had prostatitis, and the last two had pudendal neuralgia. There was a significant decrease between the median pre-PRT and post-PRT NRS scores (9 vs 3, p=0.017). Moreover, the pre-PRT and postPRT NIH-CPSI values were found to be statistically significantly different. There was no change in the designated scoring values between the pre-PRT and post-PRT scores in Cases number 2 and 4, whose etiologies were urinary bladder carcinoma. Pulsed radiofrequency therapy with PN block provides a reduction in pain severity and urination complaints and increases the quality of life of patients with CPP.

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