A novel, nonopiod‐based treatment approach to men with urologic chronic pelvic pain syndrome using ultrasound‐guided nerve hydrodissection and pelvic floor musculature trigger point injections

Abstract

Introduction: Urological chronic pelvic pain syndrome (UCPPS) represents a group of pain symptoms relating to patients with pelvic pain for which treatment is largely unsatisfactory. The objective of this study is to analyze the effects of a novel treatment strategy in males suffering from UCPPS.Methods: This retrospective, institutional review board-approved study analyzed eight male patients aged 24 to 61 with UCPPS. All the patients had a trial of antibiotic therapy, NSAIDs, and pelvic floor physical therapy before the study. The Visual Analog scale (VAS) and Functional Pelvic Pain scale (FPPS) were collected pretreatment. While continuing physical therapy, patients underwent weekly ultrasound-guided pelvic floor trigger point injections to the iliococcygeus, pubococcygeus, and puborectalis with lidocaine 1%. Concomitantly, patients received peripheral nerve hydrodissection performed on the pudendal nerve and the posterior femoral cutaneous nerve. The first two injections combined 1% lidocaine with dexamethasone, while the next four injections consisted of 1% lidocaine with traumeel (a homeopathic, plant-derived anti-inflammatory medication). At the 6-week follow-up, each patient retook the VAS and FPPS.Results: The mean age of our patients was 31.8 years and the average duration of symptoms of the UCPPS was 21 months. Pretreatment, the mean VAS was 3.3 (STD 1.7) and the mean VAS posttreatment was 1.8 (STD 1.4); P < .05; 95% CI, 0.73 to 2.27. The mean FPPS pretreatment was 11.0 Accepted Abstract and Oral Presentation for International Continence Society 2018, Philadelphia, PA.(STD 8.0) and the mean FPPS posttreatment was 6.3 (STD 5.3); P < .05; 95% CI, 0.03 to 9.22. Conclusion:Our results show promise for a novel, nonopioid-based treatment for UCPPS. K E Y W O R D Sbladder, collagen, cystometry, cystostomy, HE staining, Masson staining, rat

Botulinum toxin type A for the treatment of dyssynergic defaecation in adults: a systematic review

“…While no trial compared risks and benefits for palpation‐guided therapeutic injection against ultrasound‐guided therapeutic injection in the perianal area, ultrasound‐ or EMG‐guided therapeutic injections for muscular skeletal disorders have demonstrated superior accuracy compared with palpation‐guided injections [35,36]. Ultrasound‐guided BTXA injection in the perineum has increased in popularity in recent years [37,38]. In addition, although the rate of needle‐stick injury associated with palpation‐guided injections was not reported, blind injection in the perianal region towards the clinician’s finger seems to pose an unnecessary risk, given the potential for transmission of blood‐borne diseases.…”

A physiatrist's understanding and application of the current literature on chronic pelvic pain: a narrative review

“…To date, 2 small studies and 1 larger study of 73 women regarding its efficacy for different subpopulations of patients with CPP have shown promising results, particularly in decreasing pain and improving intercourse, sleep, and ability to go to work and sit. 54 , 77 , 84 The main limitations of these studies are that none were powered, follow-up time was short, and their retrospective design prevented the existence of control groups. 54 , 84 They set the stage for future larger prospective randomized controlled trials.…”

“… 54 , 77 , 84 The main limitations of these studies are that none were powered, follow-up time was short, and their retrospective design prevented the existence of control groups. 54 , 84 They set the stage for future larger prospective randomized controlled trials.…”

Pain and functionality improved when underlying neuromuscular dysfunction addressed in chronic pelvic pain patients

“…We aim to treat the underlying myofascial pain syndrome and neurogenic pain seen in CPP patients with our outpatient neuromuscular protocol. The effectiveness of our protocol has been studied for men and women with CPP 5,6 . The current study was performed to provide additional data for the efficacy of our protocol with a much greater sample size.…”

“…The effectiveness of our protocol has been studied for men and women with CPP. 5,6 The current study was performed to provide additional data for the efficacy of our protocol with a much greater sample size.…”