Background: Pudendal neuralgia presents as a chronic debilitating pain in the genitalia, perineum, or anorectal region. This develops as a result of damage to the pudendal nerve via irritation, previous surgeries or compression, often by other surrounding structures and tissues. Hydrodissection is a minimally invasive technique involving injection of fluid to separate layers of fascia to release entrapped nerves, emerging as a potential treatment for pudendal neuralgia. Methods: We present the case of a 36-year-old female with chronic pelvic pain that was negatively impacting her activities of daily living. The patient had previously undergone a hysterectomy procedure. The patient reported a pain score of 8/10. The patient underwent ultrasound-guided pudendal hydrodissection to address pudendal inflammation and nerve entrapment. Ultrasound-guided hydrodissection of the pudendal nerves was performed aseptically with the patient in the prone position. The procedure was performed in theatre. After skin sterilisation and local anaesthetic administered, 10mls of 5% dextrose solution was delivered using 22 g needles, on each side, to free the pudendal nerves from surrounding scar tissue and muscle adhesions with good visualisation of the distribution of solution. Outcome: Following the hydrodissection procedure, the patient experienced marked improvement in symptoms and intensity of symptoms, with sustained improvement over the six weeks follow-up (pain score 2/10). Functional outcomes including pain-free duration and improvement in activities of daily living, improved substantially. No complications were reported. Conclusion: This case supports the potential role of dextrose hydrodissection as a safe, minimally invasive treatment option for pudendal neuralgia, particularly in patients with complex pain histories and previous failed treatments. Hydrodissection offers an alternative to more invasive interventions and warrants further investigation in the management of pudendal neuralgia.
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