Pulsed radiofrequency treatment of the superior hypogastric plexus in an interstitial cystitis patient with chronic pain and symptoms refractory to oral and intravesical medications and bladder hydrodistension

Abstract

Rationale:A variety of therapeutic modalities are available for the treatment of interstitial cystitis. However, among them, the less invasive therapies are usually ineffective, whereas the invasive ones carry potential risks of serious side effects and complications. Pulsed radiofrequency (PRF) treatment of the superior hypogastric plexus may be an alternative to conventional treatments, as it provides nondestructive neuromodulation to the superior hypogastric plexus, which transmits the majority of pain signals from the pelvic viscera.Patient concerns:For 7 years, a 35-year-old female patient had been experiencing lower abdominal pain provoked by urinary bladder filling, perivulvar pain developing spontaneously during sleep or upon postural change, urinary urgency and frequency with 15- to 60-min intervals between urinations, and nocturia with 10 voids per night. Hydrodistension of the bladder, monthly intravesical administration of sterile sodium chondroitin sulfate, and oral medications including gabapentin and pentosan polysulfate had not been effective in managing the pain and symptoms.Diagnoses and interventions:Given the satisfactory result of a diagnostic block of the superior hypogastric plexus, 2 sessions of PRF treatment of the superior hypogastric plexus, which applied radiofrequency pulses with a pulse frequency of 2 Hz and a pulse width of 20 ms for 120 s twice per session to maintain the tissue temperature near the electrode at 42°C, were performed at a 6-month interval.Outcomes:This treatment relieved the pain and symptoms for 2 years and 6 months.Lessons:PRF treatment of the superior hypogastric plexus results in long-term improvements in the pain and symptoms associated with interstitial cystitis.

Interventional Radiofrequency Treatment for the Sympathetic Nervous System: A Review Article

“…These studies (excluding case series and reports) are summarized in Tables 1, 2, 3, 4, and 5. Studies involving RF treatment of the SNS primarily focused on its efficacy in CRPS (Table 1) [28][29][30][31][32][33][34][35][36], pain in the perineal region (Table 2) [37][38][39][40][41][42][43][44][45][46][47][48], headache and facial pain (Table 3) [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63], and oncologic and non-oncologic abdominal pain (Table 4) [64][65][66][67][68][69][70][71]…”

“…Similarly, CRF applied to the ganglion impar has shown success in case reports of patients with pain due to colon cancer malignancy [45] and constant anal pain [46]. Additionally, PRF was successfully applied to the superior hypogastric plexus through 2.5 years of follow-up to treat pain in a patient with interstitial cystitis [47]. Taken together, CRF and PRF of the ganglion impar both show capacity for long-term relief in pain syndromes in the perineal region.…”

Management of cyclical pelvic pain by multiple ultrasound-guided superior hypogastric plexus blocks in a rare case of Mayer-Rokitansky-Küster-Hauser syndrome - A case series of three blocks in a patient

“…A previous report described successful management of interstitial cystitis in these patients via SHPB using pulsed radiofrequency (12). For chronic pelvic pain, ablation of the uterosacral nerve via a laparoscopic or open technique has also been reported (13,14).…”

Urogenital Pain Including Pelvic Pain

“…Cases series have been described for PRF of the pudendal nerve and the ilioinguinal nerves [53,54]. E. Pelvic Floor Muscles Trigger Point Interventions 1.…”