Superior Hypogastric Plexus Block for Chronic Pelvic Pain Through an S1 Transforaminal Approach: A Case Report

Abstract

Chronic prostatitis/chronic pelvic pain syndrome (CPPS) is a debilitating syndrome commonly seen in men under the age of 50 years, which greatly impacts the quality of life. The treatment is challenging, which often requires a multimodal management approach. The superior hypogastric plexus is located anterior to L5 and S1 vertebral bodies in the retroperitoneal space and contains afferent pain fibers from most of the pelvic structures. Performing a superior hypogastric plexus block (SHPB) can potentially alleviate pain originating from various pelvic regions and structures. It is currently a viable therapy for many syndromes including endometriosis, interstitial cystitis, irritable bowel syndrome, and pain after pelvic surgery. In this case report, we present a patient who had chronic pelvic pain with a poor response to conservative management. Initially, attempts at an SHPB from the classic posterolateral approach were unsuccessful. This technique for performing this block can prove difficult due to vasculature variability or anatomic barriers, such as the iliac crest and transverse process of the fifth lumbar vertebrae. Thus, a left S1 transforaminal approach was used to block the plexus. This provided the patient with one month of near 100% pain relief, with gradual return to baseline thereafter. CPPS poses unique treatment challenges. Although often treated conservatively, SHPB is a valid treatment option for those who fail to respond adequately to other modalities. An S1 transforaminal approach is a novel and valuable alternative technique for SHPB in patients with compromising anatomy. Key words: Chronic prostatitis, chronic pelvic pain, superior hypogastric plexus, superior hypogastric plexus block, pelvic trauma, pelvic pain in men