Successful recovery of pain and voiding dysfunction using pulsed radiofrequency in sacral herpes zoster: a novel therapeutic consideration

Herpes zoster involving the lumbosacral dermatomes can rarely lead to neurogenic bladder, although most patients improve with conservative therapy.We report a 68-year-old woman with severe perineal pain and urinary retention following sacral herpes zoster.Despite antiviral therapy, systemic corticosteroids, and multimodal analgesics including caudal epidural block, her pain remained inadequately controlled.Because conservative treatment was ineffective, a pudendal nerve block was performed on the first day of referral, providing temporary relief for three days.When her pain recurred with a VAS score of 7, pulsed radiofrequency (PRF) was applied to the pudendal nerve.The procedure produced rapid and sustained pain improvement and was followed by recovery of spontaneous voiding within four days, permitting catheter removal.This case suggests that PRF on the pudendal nerve may offer dual benefit on neuropathic pain and neurogenic bladder associated with sacral neuritis when conventional therapies fail.