Ganglion Impar Neurolysis Enhances the Short-term Efficacy of Pudendal Nerve Pulsed Radiofrequency Treatment for Pudendal Neuralgia: A Retrospective Cohort Study.

Abstract

Pudendal neuralgia (PN) lacks specific treatments and severely affects patients' quality of life. Although pudendal nerve pulsed radiofrequency (PRF) can alleviate symptoms, its overall efficacy is not satisfactory. Ganglion impar neurolysis (GIN) has been widely employed for perineal pain management. We hypothesize that combining PRF with GIN may enhance therapeutic outcomes for PN compared to PRF monotherapy. To the best of our knowledge, no relevant reports have been found. To assess whether GIN improves PRF treatment efficacy for PN. A retrospective cohort study. This is a single-center retrospective study conducted at the Department of Pain Medicine, Peking University People's Hospital in Beijing, China. We conducted a retrospective analysis of 84 women patients with PN treated from January 2020 through February 2024. The patients were divided into 2 groups: PRF Group (n = 40) received only pudendal nerve PRF; PRF + GIN Group (n = 44) received PRF combined with GIN. We recorded the posttreatment differences in Visual Analog Scale (VAS) scores, Overall Improvement in Pain (OIP) values, Hospital Anxiety and Depression Scales scores (anxiety: HADS-A; depression: HADS-D), and Pain Catastrophizing Scale scores (PCS) of the 2 groups at time points up to posttreatment month 6. At one, 2, 3, and 6 months posttreatment, the VAS scores in both groups were lower than pretreatment levels (P < 0.05). At 6 months posttreatment, the mean (SD) VAS score in the PRF+GIN Group (2.09 [1.38]) was lower than that in the PRF Group (3.81 [1.85]) (P < 0.05). The mean (SD) OIP value in the PRF+GIN group (73.72% [17.27%]) was higher than that in the PRF Group (56.13% [26.90%]) (P < 0.05). At 3 and 6 months posttreatment, the HAD scores and PCS scores in both groups were lower than pretreatment levels (P < 0.05). At 6 months posttreatment, the mean (SD) HADS-A and HADS-D scores in the PRF+GIN Group-3.91 (2.70) and 3.37 (2.18), respectively-were lower than those in the PRF group-6.54 (3.75) and 5.55 (3.25), respectively (P < 0.05); the mean (SD) PCS score in the PRF+GIN Group 12.16 (6.16) was lower than that in the PRF Group 19.52 (9.92) (P < 0.05). No severe complications were observed at any posttreatment time point. This single-center study has a small sample size, a short follow-up period, and lacks patients who are men. GIN enhances short-term pudendal nerve PRF efficacy for PN, with no significant adverse reactions.