Cryoablation Protocol Yielding Remarkable Results
Posted: Tue Jun 11, 2024 4:46 am
Pelvic PT Specialist Stephanie Pendergast posted an interview she did with Dr. John David Prologo of Emory University in Atlanta where he describes a cryoablation protocol that applies cold 3 - 4 times longer than the 'standard" protocol. Results of that treatment almost aways last a few months, at best. That due to the ability of A and C nerve fibers to regrow.
Most doctors apply two cycles of 2 - 3 minutes of hitting the pudendal nerve with a freezing cold gas, which causes a ball of ice to form on the nerve, There's a couple of minutes long pause between applications. Dr. Prologo uses two 8 minutes of cooling with a 4 minute warming period in-between.
He claims everyone he's treated in this manner is still getting the benefit from treatment 4 years later! THAT is incredible!
Hes a link to the interview. I'll include excerpts in case it's ever taken down.
https://pelvicpainrehab.com/blog/cryoth ... neuralgia/
Sara: Is your technique for treating pudendal neuralgia called cryoablation or is it different from cryoablation?
Dr. Prologo: This technique is indeed cryoablation. The unique thing about what we are doing, though – is the implementation of image guidance. We are using our interventional radiology training and evolving image guidance techniques to access nerves that are deep in the body and otherwise inaccessible for injections or ablations, in this case the pudendal canal.
Sara: How is your technique different from pulsed radiofrequency ablation?
Dr. Prologo: Radiofrequency ablation is heat mediated tissue destruction. Cryoablation creates shifts in osmotic gradients and intracellular ice crystals that ultimately results in the shutting off of nerve signals, more like turning down the volume of the stereo vs. blowing it up with a bomb.
Sara: Why do you prefer freezing versus burning?
Dr. Prologo: 1) Cryoablation is great for pain procedures because it is not painful 2) Cryoablation creates an “ice ball” that we can see on CT. Therefore there is no guesswork involved with where we ablated 3) Cryoablation initiates a unique immune response that a) results in longer lasting results and b) stops neuroma formation (vs. radiofrequency ablation or surgery)
Sara: What are the results you are getting?
Dr. Prologo: Our results have been largely durable and positive. That is, the great majority of our patients experience complete relief from their symptoms. That said, pain can be complicated and outcome depends heavily on patient selection.
Sara: Have you followed your patients from four years ago?
Dr. Prologo: I am in touch with most of the patients that were done and they are still doing well.
Sara: What are the side effects?
Dr. Prologo: We have not seen any side effects to date.
Sara: Any long term issues?
Dr. Prologo: Not that we are aware of at this point.
Sara: Is it possible that you are inadvertently treating the posterior femoral cutaneous nerve as well?
Dr. Prologo: No. The ablation zone and CT scanning are both exquisitely precise. This is actually the epicenter of the new therapies and innovation. That is, it isn’t really the cryo that is new, it’s the advanced imaging guidance to treat pain. The techniques are so precise that we can literally treat 2mm nerves in the skull base.
Sara: Who is an appropriate referral?
Dr. Prologo: This is key. Patients who have been diagnosed with pudendal neuralgia are most likely to benefit. That said, many patients come with a wide variety of backgrounds and symptom descriptions. As a result, we can get everyone to the same starting point by performing a diagnostic “test injection.” Again, because we have CT, we can see with 100% certainty where our injection ends up. As a result, there is not guess work. If the patients symptoms improve with the test injection, then they will do well with the cryo. If not, then they don’t have pudendal neuralgia and some other therapy is warranted. That said, interventional radiologists also treat pelvic congestion syndrome, which can be misdiagnosed as pudendal neuralgia.
Most doctors apply two cycles of 2 - 3 minutes of hitting the pudendal nerve with a freezing cold gas, which causes a ball of ice to form on the nerve, There's a couple of minutes long pause between applications. Dr. Prologo uses two 8 minutes of cooling with a 4 minute warming period in-between.
He claims everyone he's treated in this manner is still getting the benefit from treatment 4 years later! THAT is incredible!
Hes a link to the interview. I'll include excerpts in case it's ever taken down.
https://pelvicpainrehab.com/blog/cryoth ... neuralgia/
Sara: Is your technique for treating pudendal neuralgia called cryoablation or is it different from cryoablation?
Dr. Prologo: This technique is indeed cryoablation. The unique thing about what we are doing, though – is the implementation of image guidance. We are using our interventional radiology training and evolving image guidance techniques to access nerves that are deep in the body and otherwise inaccessible for injections or ablations, in this case the pudendal canal.
Sara: How is your technique different from pulsed radiofrequency ablation?
Dr. Prologo: Radiofrequency ablation is heat mediated tissue destruction. Cryoablation creates shifts in osmotic gradients and intracellular ice crystals that ultimately results in the shutting off of nerve signals, more like turning down the volume of the stereo vs. blowing it up with a bomb.
Sara: Why do you prefer freezing versus burning?
Dr. Prologo: 1) Cryoablation is great for pain procedures because it is not painful 2) Cryoablation creates an “ice ball” that we can see on CT. Therefore there is no guesswork involved with where we ablated 3) Cryoablation initiates a unique immune response that a) results in longer lasting results and b) stops neuroma formation (vs. radiofrequency ablation or surgery)
Sara: What are the results you are getting?
Dr. Prologo: Our results have been largely durable and positive. That is, the great majority of our patients experience complete relief from their symptoms. That said, pain can be complicated and outcome depends heavily on patient selection.
Sara: Have you followed your patients from four years ago?
Dr. Prologo: I am in touch with most of the patients that were done and they are still doing well.
Sara: What are the side effects?
Dr. Prologo: We have not seen any side effects to date.
Sara: Any long term issues?
Dr. Prologo: Not that we are aware of at this point.
Sara: Is it possible that you are inadvertently treating the posterior femoral cutaneous nerve as well?
Dr. Prologo: No. The ablation zone and CT scanning are both exquisitely precise. This is actually the epicenter of the new therapies and innovation. That is, it isn’t really the cryo that is new, it’s the advanced imaging guidance to treat pain. The techniques are so precise that we can literally treat 2mm nerves in the skull base.
Sara: Who is an appropriate referral?
Dr. Prologo: This is key. Patients who have been diagnosed with pudendal neuralgia are most likely to benefit. That said, many patients come with a wide variety of backgrounds and symptom descriptions. As a result, we can get everyone to the same starting point by performing a diagnostic “test injection.” Again, because we have CT, we can see with 100% certainty where our injection ends up. As a result, there is not guess work. If the patients symptoms improve with the test injection, then they will do well with the cryo. If not, then they don’t have pudendal neuralgia and some other therapy is warranted. That said, interventional radiologists also treat pelvic congestion syndrome, which can be misdiagnosed as pudendal neuralgia.