We included 28 patients (8 males, aged 34–68 y.o.) suffering from extensive pelvic pain with different patterns, location, from low back pain and LUTS. Inclusuion criteria: pelvic pain of different pattern inguinal, pubic, vulvodynia, rectal pain, LUTS. Any relevant urological gynecological disease excluded. Healthy 20 individuals (18–53, 10 males) were controls.
All patients underwent general examination, MRI, precise physical tests, extensive functional multilevel multiparameter neuromuscular US  using 4-8 MHz/5-12 MHz probes in shoulder, sacroiliac junction (SIJ), intervetrebral spaces, foot, ankle, gluteus region and pelvis, abdominal wall, diaphragm and pelvic floor motility. We did M-mode, transient elastography and shear wave elastography (SWE) of nerves and muscles, evaluated structure, CSA, detecting compressions, contact to scars, muscle TrPs, spasticity and evaluated nerve motion and SWE during overstraining neurodynamic tests.
All patients underwent transabdominal pelvic ultrasound for evaluation bladder neck motility. Transabdominal US measurements of bladder neck rotation in a postero-inferior direction at rest and on maximal Valsalva was performed to all patients. Measurements were taken at rest and on maximal Valsalva, and the difference yields a numerical value for bladder neck descent.
We evaluated bladder motion, deformation, determined side of deviating bladder (according to the position/tone of psoas muscle) before and after intervention.
Then patients received DN of detected MTrP under US guidance.
Approches for needling. The treatment approach by [Evidence-based pain management: is the concept of integrative medicine applicable? EPMA Journal 3, 13 (2012). https://doi.org/10.1186/1878-5085-3-13] was applied, that included ultrasound identification of MTrPs with following dry needling under US guidance using steel acupuncture needles (28 gage) to elicit the LTR effect. Retention of needles depended of muscle twitch response duration. Visual analogue scale data (0 to 10) were measured before, immediately after and 24 hours after the intervention.