Clinical Criteria for Improved Outcomes in Patients Who Undergo Percutaneous CT-Guided Pudendal Nerve Cryoablation: A...

To evaluate whether predefined clinical selection criteria were associated with improved outcomes following computed tomography (CT)-guided pudendal nerve cryoablation.

A retrospective review of 362 CT-guided pudendal nerve cryoablations was performed at a multisite, tertiary-care, academic center over a 10-year period (2014-2024). Among 202 unilateral procedures, 75 (37.1%) had adequate follow-up and were included in the primary analysis. Patient stratification was performed by presence of predefined selection criteria, namely, identifiable antecedent event, unilateral perineal pain consistent with pudendal distribution, and positive response to CT-guided diagnostic pudendal block. The primary endpoint was ≥50% pain reduction on a 0-10 numerical rating scale. Mean percent pain reduction, reintervention interval, and adverse events (Society of Interventional Radiology [SIR] classification) were recorded. Fischer exact test, chi-square test, and multivariate logistic regression were performed where appropriate. Significance level was set at P < .05.

Among 75 unilateral procedures with adequate follow-up, 49 (65.3%) achieved ≥50% pain reduction. Procedures performed on patients meeting all predefined criteria (53 procedures in 33 patients) demonstrated higher response rates than those not meeting all criteria (77.4% vs 36.4%, χ²P = .002) and greater mean pain reduction (69.1% vs 29.5%, P < .001). In criteria-positive responders, mean pain reduction was 88.8%. Among 15 patients undergoing repeat procedures with follow-up, the mean time to reintervention was 31.8 months after a positive response. No major (SIR C-F) adverse events were observed.

Patients who met all predefined clinical selection criteria had significantly greater positive outcomes following CT-guided pudendal nerve cryoablation compared than those who did not.