Pudendal nerve cryoneurolysis

Pudendal nerve cryoneurolysis is used to relieve the chronic debilitating pain associated with pudendal neuralgia. This technique is considered to be an alternative to traditional pain-relieving treatments such as pain medication, corticosteroid injections or physiotherapy.

Pudendal nerve cryoneurolysis is a minimally invasive procedure performed daily at the American Hospital of Paris. Our interventional radiology team, made up of experienced physicians, uses latest-generation equipment that ensures safety for our patients.

THE PROCEDURE

Pudendal nerve cryoneurolysis is a minimally invasive procedure performed on an outpatient basis under local anesthesia by an interventional radiologist, with no need for hospitalization. The technique combines a surgical act with an imaging exam, which allows the doctor to monitor the procedure in real time. The aim of the procedure is to eliminate or reduce the pain associated with pudendal neuralgia.

Cryoneurolysis consists in applying extreme cold (-70°C) to the nerve causing the pain, in order to relieve painful symptoms. This exposure to extreme cold damages the nerve, preventing it from sending pain signals. The procedure itself is pain-free.

After the freezing phase, the probe is warmed up and removed. A bandage is placed over the puncture site, and the procedure is over.

In the months following the procedure, the nerve regeneration process is naturally induced. Patients can expect an almost immediate recovery and rapid long-term relief of their painful symptoms.

PROCEDURE DURATION

The duration of the procedure may differ based on its complexity, but on average lasts one hour. Our medical team will monitor your condition throughout the procedure to make sure everything is going smoothly.

Postoperative follow-up

There is no need for in-hospital monitoring following pudendal nerve cryoneurolysis, so patients can return home after the procedure. Because it is a minimally invasive procedure, recovery is very quick and there are no cosmetic side effects.

Follow-up consultations are scheduled to ensure you are recovering well and to detect any complications. It is important to follow the doctor’s post-operative instructions to ensure optimal recovery and reduce the risk of complications.

Our medical team will be there to support you throughout every step of your treatment. Our 24/7 hotline is available to answer any questions you may have. Our aim is to provide you the best care and ensure your patient experience at the American Hospital of Paris is as comfortable as possible.

Cost and reimbursement

Assurance Maladie, the French health insurance, does not offer a high reimbursement rate for pudendal nerve cryoneurolysis. A surcharge due to physicians’ fees and hospitalization expenses is highly probable, but these charges are systematically determined with tact and moderation based on recommendations issued by the French Board of Physicians.

Before the procedure, the interventional radiologist will explain to you in detail the different steps of pudendal nerve cryoneurolysis. You will also be given instructions to ensure you are well prepared. You will need to inform your doctor about your medical history, allergies and any treatments in progress.

On the day of your consultation, please bring the following documents:

• Lab reports
• Imaging exam results
• Blood test results
• List of your medications

Pudendal nerve cryoneurolysis has proven to be effective in the relief of chronic pain caused by pudendal neuralgia. The results are noticeable in the very first days following the procedure, and are often long-lasting.

Two recent studies examined the use of this procedure to treat refractory pudendal neuralgia and pelvic pain in patients suffering from pelvic tumors.

In the first study, the researchers selected 11 patients to undergo pudendal nerve cryoablation under CT-scan guidance1. Prior to the treatment, patients reported an average pain level of 7.6 on a scale of 0 to 10, describing the pain as “burning,” “crushing,” or “shooting.” Following the treatment, patients reported a significant reduction in pain at 24 hours, 45 days and 6 months, with respective pain levels of 2.6, 3.5 and 3.1. In addition, they experienced no side-effects from the procedure.

The second study examined the use of bilateral pudendal nerve cryoablation to treat pelvic pain in patients suffering from pelvic tumors2. The researchers examined 10 patients who underwent this procedure between June 2014 and January 2019. All of the procedures were performed without complications or an associated adverse event. There was a significant mean difference between the most severe pain scores before and after treatment.

These two studies suggest that pudendal nerve cryoablation can be a safe and effective option to relieve refractory pelvic pain in patients with pudendal neuralgia or pelvic tumors. Although additional studies are necessary to confirm these results, they are very promising. 

Sources

1.       https://pubmed.ncbi.nlm.nih.gov/25511935/

2.       https://journals.sagepub.com/doi/abs/10.1177/1049909119892003  

Because pudendal nerve cryoneurolysis is a minimally invasive procedure, it carries a very low risk of complication compared to its surgical alternative, and its benefits far outweigh those of surgery.

Cryoablation may cause:

• Bruising at the needle puncture site
• Skin burns
• Risk of bleeding
• Temporary pain in the treated area
• Tingling or numbing sensations
• Infection in the treated area (very rare)