93 - Safety and Efficacy of CT-guided Inferior Hypogastric Nerve Alcohol or Cryo-neurolysis For the Management of Multifactorial Intractable Pelvic pain: A Single Institution Experience

The inferior hypogastric nerves are formed by the pelvic splanchnic/sacral splanchnic nerves, pelvic visceral afferent fibers, and the superior hypogastric plexus {1}. The nerve provides sensation to the urogenital region and rectal viscera {1}. One small prospective study is available in the literature evaluating fluoroscopy guided alcohol neurolysis of the inferior hypogastric plexus for pelvic pain related to cancer {2}. Our goal is to provide the largest retrospective single institution experience on the safety and efficacy of CT-guided inferior hypogastric nerve alcohol or cryo-neurolysis for the management of multifactorial intractable pelvic pain. 

Materials and Methods:

The electronic medical record was queried for patients who underwent CT-guided inferior hypogastric nerve alcohol or cryo-neurolysis from 2020-2024 for pelvic pain. Cohort was analyzed for demographics, etiology (post-traumatic/surgical, neoplastic, miscellaneous), complications, treatment response (≥50% reduction in pain scores), time to follow-up, and reintervention. T-test and Fisher’s Exact were used to evaluate the effect of the aforementioned factors on efficacy and re-intervention (P value ≤ 0.05). 

Results:

Analysis of 31 patients showed all procedures were performed successfully without complication. Most patients underwent alcohol neurolysis (93.5%). Most patients were female (71%) and presented with pelvic pain related to a miscellaneous process (58.1%, for example pelvic arteriovenous malformation). Average pre/postprocedural pain scores were 8 (SD 2) and 7 (SD 3), respectively. Both pre/postprocedural pain scores were available for 26 patients of which 6 (23.1%) responded to treatment. Of note, all patients who responded to treatment initially presented with rectal/perianal (2) or deep pelvic pain (4). Median post-procedural time to follow-up was 2.3 months (1-3 months). Re-intervention occurred in 20 patients (64.5%).  Positive treatment response or reintervention were not significantly associated with any factors or type of neurolysis. Interestingly, at least 74% of patients had undergone some form of image-guided pain intervention for pelvic pain prior to their inferior hypogastric nerve neurolysis. 

Conclusion: CT-guided alcohol or cryo-neurolysis of the inferior hypogastric nerves is safe but has limited efficacy and should instead be used as an alternative rather than first-line option, particularly for patients presenting with complex rectal/perianal or deep pelvic pain. Larger retrospective and prospective studies are needed to help guide patient selection.