Evidence and experience
What the evidence and two decades of surgical experience say about pudendal nerve block.
An image-guided pudendal nerve block places local anaesthetic precisely around the nerve. If the pain drops substantially for the duration of the anaesthetic, that is powerful evidence the pudendal nerve is generating the pain.
A block is a diagnostic instrument first and a treatment second. Temporary relief is useful information; lasting relief is a bonus. Either way the response shapes what happens next.
Dr Bollens uses block response, symptom mapping and imaging together. Surgery is only recommended when those three lines of evidence agree — which is why we decline to operate on some patients who come to us expecting it.
Dr Bollens is a professor of urology, a proctor in pelvic surgery and a published author on pudendal neuralgia.