Sympathetic blocks for the treatment of chronic pelvic/perineal pain secondary to recurrent urinary tract infection

Abstract

Interventional management of pain has been described as the 4th step of the WHO analgesic ladder and proves immensely useful for many refractory and resistant pains. Recurrent urinary tract infection (UTI) can lead to chronic pelvic and perineal pain, which are often refractory to analgesics including strong opioids, and requires centrally acting neuropathic pain medications, along with psychological and behavioral therapies, and may need interventional pain management. Sympathetic nerve blocks are indicated and can be used in management of visceral pain/cancer pain. A patient with cancer may experience pain due to cancer, side effects of its treatment, or a noncancer pathology. They are prone to recurrent infections including urinary tract, respiratory tract, bloodstream infections, among others, which become a common cause of morbidity and mortality in patients with cancer. In this case report, the authors present a case with advanced cancer in whom recurrent UTI led to chronic debilitating perineal pain which was successfully managed with superior hypogastric plexus and ganglion impar block highlighting the potential utility of these underutilized blocks in challenging situations of complex pelvic and perineal pains.

Keywords

• case report
• ganglion impar
• gynecology
• integration
• interventional pain management
• neurolysis
• pelvic pain
• perineal pain
• quality of life
• superior hypogastric plexus
• sympathetic block
• urinary tract infection
• urology