CT-guided pulsed radiofrequency of sacral and pudendal nerves for herpes zoster-related neurogenic lower urinary tract dysfunction in male patients: a retrospective study.

OBJECTIVES

To evaluate the efficacy of CT-guided pulsed radiofrequency (PRF) neuromodulation targeting the sacral nerves (S2-S4) and the pudendal nerve in male patients with herpes zoster-related neurogenic lower urinary tract dysfunction (NLUTD), a condition lacking effective treatment and significantly impairing quality of life.

MATERIALS AND

METHODS

A retrospective analysis was conducted on 15 male patients with herpes zoster-related NLUTD who underwent CT-guided PRF treatment between 2024 and 2025. PRF was applied to the sacral nerve roots (S2-S4) and the pudendal nerve. Clinical outcomes were assessed using residual urine volume and Visual Analog Scale (VAS) scores for pain. Most patients received two to three treatment sessions. A 12-week follow-up was conducted, and quality of life was evaluated using the 36-Item Short Form Health Survey (SF-36).

RESULTS

PRF treatment resulted in significant and sustained improvements in both urinary function and pain. Residual urine volume decreased markedly from 174.7 ± 43.1 mL at baseline to 29.3 ± 42.2 mL at 12 weeks, while VAS scores declined from 5.8 ± 1.0 to 0.9 ± 1.1. Health-related quality of life also improved significantly, as reflected by reductions in KHQ (73.47 ± 7.17 to 27.27 ± 12.79) and IIQ-7 scores (17.40 ± 1.72 to 5.07 ± 3.01; p < 0.05). Clinical benefits were evident after the first session and further enhanced with repeated treatments, with most patients achieving near-complete symptom resolution at 12 weeks and no recurrence of urinary retention.

CONCLUSION

CT-guided PRF neuromodulation of the sacral and pudendal nerves demonstrates significant therapeutic value for male NLUTD secondary to herpes zoster, providing durable improvements in pain relief, urinary function, and quality of life (SF-36) over a 12-week observation period. The dual neuromodulatory approach is safe and warrants further prospective validation.