A Novel, Non-Opiod Based Treatment Approach to Men with Urologic Chronic Pelvic Pain Syndrome (UCPPS) Using Ultrasound Guided Nerve Hydrodissection and Pelvic Floor Musculature Trigger Point Injections

Shrikhande A1, Bayer- Mertens Human A1, Ahmed T1, Shrikhande G1, Hill C1

Research Type

Clinical

Abstract Category

Pelvic Pain Syndromes / Sexual Dysfunction

Abstract 306
Potpourri
Scientific Podium Short Oral Session 19
Thursday 30th August 2018
12:05 - 12:12
Hall B
Pain, Pelvic/Perineal Pelvic Floor Male
1. Pelvic Rehabilitation Medicine- Northwell Health
Presenter
A

Allyson Shrikhande

Links

Abstract

Hypothesis / aims of study
Urological Chronic Pelvic Pain Syndrome (UCPPS) represents a group of pain symptoms relating to patients with pelvic pain that are poorly understood and for which treatment is largely unsatisfactory. Newer nomenclature has combined Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) and Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) into a single classification of UCPPS. The objective of this study is to analyze the effects of a novel treatment strategy in males suffering from UCPPS.
Study design, materials and methods
This retrospective, institutional review board approved study analyzed eight male patients aged 24-61 with UCPPS.  All patients had a trial of antibiotic therapy, and had pelvic floor physical therapy pre and post taking part in the study. Patient’s scores on the Visual Analogue Scale (VAS) and Functional Pelvic Pain Scale (FPPS) were collected pre-treatment (Figure 1).  While continuing physical therapy, patients underwent ultrasound guided pelvic floor trigger point injections to the iliococcygeus, pubococcygeus, and puborectalis. The first two injections combined 1% lidocaine with dexamethasone, while the next 4 injections consisted of 1%lidocaine with traumeel (a homeopathic, plant derived anti-inflammatory medication). Concomitantly, patients received peripheral nerve hydrodissection performed on the pudendal nerve and the posterior femoral cutaneous nerve. These treatments allow the nerves to reset, decreasing hypersensitivity.  These treatments lasted for 6 weeks.  After completion of treatment, 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. Pre−treatment, the mean VAS was 3.3 (STD 1.7) and the mean VAS post-treatment was 1.8 (STD 1.4); P<0.05, 95% CI 0.73-2.27.  The mean FPPS pre-treatment was 11.0 (STD 8.0) and the mean FPPS post treatment was 6.3 (STD 5.3); P<0.05, 95% CI 0.03-9.22.
Interpretation of results
Our results show promise for a novel, non-opiod based treatment for UCPPS by using ultrasound guided pelvic floor trigger point injections combined with peripheral nerve hydrodissection with lidocaine, traumeel, and dexamethasone along with a pelvic floor physical therapy program.
Concluding message
This novel approach at treating UCPPS using by using ultrasound guided pelvic floor trigger point injections combined with peripheral nerve hydrodissection is a promising treatment option for males suffering from this chronic painful medical condition.