Meet Dr. David Prologo

Have you heard of him?  I had not until just a few weeks ago.  I heard a rumor that he is doing some great stuff with pudendal neuralgia.  He is an interventional radiologist located at Emory in Atlanta, Georgia.  He is doing cryoablation to the pudendal nerve with use of CT-guidance.

See, interventional radiologists are the guys that are doing pudendal blocks with CT-guidance in the first place.  They are also the vein guys.  They treat pelvic congestion.  So, how perfect that Dr. Prologo treats both.  Makes sense, right?  Especially if  pelvic congestion created your pudendal neuralgia.  (The varicose veins can distend so much that it puts pressure on your pudendal nerve – or other nerves.)  If you don’t know much about pelvic congestion, then check out my post on it.  Click here.

So I hear about Dr. Prologo, I google him and the first image that pops up is the face of a very cheerful man.  I think, “Oh. He is happy.  Good.  I will email this happy doctor.”  And I do.  And he writes back.  Right away.  He allows me to basically interrogate him.  Here is a bit of our conversation:

  1. Sara: Is your technique for treating pudendal neuralgia called cryoablation or is it different from cryoablation?

Prologo_DavidDr. 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.

2. 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.

3.  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)

4.  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.

5.  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.

6.  Sara: What are the side effects?

Dr. Prologo: We have not seen any side effects to date.

7.  Sara: Any long term issues?

Dr. Prologo: Not that we are aware of at this point.

8.  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.

9.  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.

10.  Sara: Explain the process.  Do patients fly in for an evaluation and receive treatment or do they have to fly back for treatment?

Dr. Prologo: No. We have developed a system in which patients who have stories reflecting underlying pudendal neuralgia – or some close variant – come in for a consultation and injection on the same day. Usually, we also schedule the cryo for the following day so everything can be done in one trip. If the patient fails the injection, we just cancel the cryo.

11.  Sara: What does treatment consist of?

Dr. Prologo: We place a needle in CT in the pudendal canal. The needle is configured to create a 3cm x 2cm ablation zone about its center. We freeze for 8 minutes, thaw for 4 minutes, freeze for 8 minutes, and thaw for a final 4 minutes – after which we pull the needle/probe.

12.  Sara:  How long do patients stay in town after the treatment for pudendal neuralgia?

Dr. Prologo: I encourage patients to at least stay the night of the procedure. That way, if there happens to be a complication (bleed, for example) we can take care of them here.

13.  Sara:  Do you freeze the whole nerve or different branches of the nerve?

Dr. Prologo:  We freeze the portion that runs in Alcocks’s canal (the pudendal canal).

14.  Sara:  Are you doing a pelvic exam to confirm your diagnosis of pudendal neuralgia or are you going by verbal report of symptoms alone?

Dr. Prologo:  No. It is all about the injection. We have the luxury of being able to make the diagnosis based on the injection because of precision imaging. We shut down the nerve with 100% certainty in order to make or exclude the diagnosis of pudendal neuralgia.

15.  Sara:  Are you familiar with Interstitial Cystitis?

Dr. Prologo:  Yes.

16.  Sara: Are you seeing your patients’ Interstitial Cystitis symptoms resolve?

Dr. Prologo:  We usually don’t treat this condition with this procedure. I think it may be helpful for folks to understand the larger picture. We have been lucky enough to be able to treat many conditions by accessing nerves with image guidance (phantom limb pain, occipital neuralgia, cancer pain, and more). Pudendal neuralgia is one of these subsets.

17.  Sara:  Does insurance cover treatment?

Dr. Prologo:  So far >90% of cases have been covered without incident. Sometimes we need to call or write a letter if the patient is out of network.

18.  Sara:  Will you be presenting your treatment at any pelvic pain conferences?

Dr. Prologo:  I have thought about this, but have not pursued it. I presented a few years back at our conference (Society of Interventional Radiology) but I think more interested parties may be at the pelvic pain conferences.  

I would like to add that 1) I didn’t invent this. I was trying to help patients with cancer pain using cryoablation and God put these patients with nerve pain in my path (pudendal, greater occipital, phantom limb, etc) so I feel like it is my responsibility to do the best I can to help them. I have been so fortunate and blessed to have met so many beautiful people because of the way this thing has worked out. In the end, my only motivation for continuing to do this is to help folks.  2) as I mentioned earlier, the therapy is one application in a much larger picture – the use of image guidance for the treatment of pain. As data emerges regarding the safety and efficacy of these procedures, we will continue to grow and hopefully help even more patients. We appreciate the privilege to participate in each and everyone of these patients’ lives, hopefully toward the better. 

Thank you Dr. Prologo for metaphorically sitting down with me, letting me shine a super bright light in your eyes and continuing to answer my questions despite my Cheetoh breath and complete lack of etiquette.  You are patient.  I am a salivating, rabid dog hungry for some answers.

If you have any questions or comments please leave them anonymously in the comment section below or email me at [email protected]

52 thoughts on “Meet Dr. David Prologo”

    1. Great post. However, under question 17; I was told by Emory’s finance department that Medicaid is currently the ONLY insurance that covering the pudendal cryoablation procedure. My insurance is currently denying coverage. Especially without prior authorization.

  1. I agree with Jack. Thank you so much for this excellent interview with Dr. Prologo. It was extremely informative and helpful. I think I am going to schedule an appt. with him.

  2. Sara, once again you are so eager to get answers, and help patients get the help they need regardless of where it is. You are awesome!!! Thank you very much, and thanks to Dr. Prologo. I wish he was in my backyard.
    I just had a well known pain management doc tell me to stay away from CT for blocks. Do you have any concerns on the amount of radiation patients receive with CT procedures? Also, is the “test” injection a a typical pudendal nerve block? Thanks!

    1. Hi Debbie,

      I’m not sure if your pain management doctor was telling you specifically to stay away from CT or if he thinks everyone should stay away. I have never thought about the radiation a patient receives with a CT procedure. This would be a great question for me to ask someone.

      The test injection is CT-guided pudendal block. I am making the assumption that it is not using steroids, but I did not ask him that.

      Sara

  3. What about Workers Comp? My accident happened as work injury. My health insurance refuses to cover these costs as due to work injury.

  4. This is so special. I found Dr. Prologo about a month ago while my never ending search has been for nine years. The same day a person on another blog site for pain mentioned his name and referenced his article, not this interview. I saw Dr Prologo and made an appointment for the first part, the CT guided injection. I saw him yesterday for this and then late last nite I saw this in my email. I had to read it right then. This is God working in my life. Since I live in metro Atlanta I see him again in 1( days for the cryoablation. Yes, I did feel relief yesterday. I actually did. I was so reluctant to get my hopes up but was by no means feeling defeated. I prayed I had others praying for me and I am thankful beyond words. The farthest I had been traveling was to South Carolina. I was getting trigger point injections intravaginally with no guidance but with the feeling around for the worse pain sites. These worked also but every three months I was traveling. After reading that the cryoablation could work and he has had such a high success rate I had to make an appointment. Dr Prologo is a God send. His willingness and heart for helping people in pain is awesome. I will keep everyone updated.

    1. Hello Carol. Did you have the procedure? How was your outcome? You are blazing trails and we are all rooting for you.

    2. Carol, there are many patients curious about your results if you had the procedure. Since this is new, patient testimonials is all we have until studies/statistics are published…and that will be years. Hope you check in.

    3. Hi Carol,I hope you are doing well! I too did the diagnostic blocks with Dr Prolog but have not yet proceeded with cryoablation. How did it go for you?

      1. Bob, My husband also suffers. We have 3 questions on our minds before proceeding, and thought you may have been given some of the answers. How many of the cryo ablations has he done for men? In another article it was mentioned 60% of women had no side affects. Did he give you a range of possible side affects for the other 40% who did experience some? Is this procedure permanent, or does it need to be repeated later. We would have to travel 19 hours by car or two flights to see him. When calling to ask questions, we were told he and/or his nurse take no calls, that we would have to make an appointment to get the answers. Thanks for any information you can give us.

    4. Hi Carol,

      In so glad that you’re feeling the relief. I’m trembling to ask cause I don’t want to see No for an answer but does Dr. Prologo see male patients as well? Can he perform cryloblation on men too? He’s practically my last hope.

      Thank you so much!
      Raj

    5. Hi Carol, really hope your cryloblation went well. Like the other sufferers, I’m eagerly waiting to hear about your treatment. Would also like to speak with you if possible. My email is [email protected].

      Regards
      Raj

    6. I too have been struggling with padendul nostalgia for 3 years having the ct guided blocks about 2 – 3 times a year. They help me for about 3 months then pain is back.
      My doctors feel i’m a good canidate for this procedure. I’m a little apprehensive because rhey told me it could work or do the opposite and i’d be worse. Is this true Dr. Prologo? I am desperate. I still work and try to libe a normal lifestyle but, it is not Easy.
      Lisa

  5. As it turns out, I had just recently stumbled across an article about Dr. Prologo online when I was researching the pudendal nerve. The treatment sounded so promising but I could find very limited information about it so I had to wonder if this was all legit. Thank you, Sara, oh warrior goddess, for always being proactive, inquisitive and assertive on behalf of your patients and readers by getting to the bottom of this matter for us. Like Debbie, I am somewhat unclear as to whether the diagnostic injection Dr. Prologo refers to in the interview is a pudendal nerve block (say, with Lidocaine) or did you get the impression it was something altogether different?

    To Carol: I know everyone here joins me in sending our best wishes and hopes for a successful outcome.

    1. Hi Steve,

      Yes, Dr. Prologo does cryoablation on men.

      Dr. Conway and Dr. Echenberg and Dr. Dellon on the east coast also treat men.

      Sara

    1. Hi Jill,

      I can’t speak for Dr. Prologo, but I would imagine that cryoablation would affect any issue that is caused by pudendal neuralgia. Some people with vulvodynia might find relief, others who have vulvodynia from another root cause might not.

      Sara

      1. I am looking for a Doctor to treat my vulvodynia.Should I consult with Dr. Prologo?I have been to gyn and dermatologists and P.T.

        Thanks
        jamie

    1. Cindy, was your genital femoral nerve damaged from surgery?
      Mine was from tacks used in hernia repair to hold mesh. My PN far predated this, but now have the two issues.

    2. Hi Cindy,

      Yes, I’m pretty sure he does cryoablation on the genitofemoral nerve. I do not know if he does this at the same time as the pudendal nerve.

      Sara

  6. Does anyone know how much this would cost without insurance? I’m from Australia and considering traveling to see him. Thanks Eliza

  7. I emailed Dr. Prologo and got a quick response. They sent a questionaire/history profile request for no cost/obligation registration. I’d like to get feedback from a number of patients first; keeping this option on top of list once I learn more.
    Sara, are you aware of any forum/site where patients who had cryo provided feedback?

    1. Hi SteveF,

      I do know that people are discussing him on forums and sites providing feedback, however, I don’t know which specific sites those are. I’m not a member of any sites that patients classically go on.

      Sara

  8. I go to see dr prologo next week . His protocol has changed tgere has to be a two week gap for the first initial test to the actual freezing . If you are going through your insurance company .
    So tvat means two trips to Georgia .
    Has anyone else been to him .
    I have had the testing for the pudendsl nerve done here in Houston . I faxed the paperwork over . But they wil not except any work done by my radiologist . Hence two trips . This upset me a bit as I feel it’s such a journey to make even once .
    So I’m lying here wondering why he will not accept my radiologist results . Done exactly the way they do there’s .

  9. I am considering seeing Dr. Prologo for pudendal neualgia. There is confusion in the appropriate medical literature as well as with my doctors here in Florida. My pelvic pain PT is not really working that well. I do, however, adore both of the Pelvic Pain physical therapists I am working with. They are dedicated and careful.

    The medical literarure as well as my doctors here in Florida seem to be convinced that “real” pudendal neuralgia always has urinary and fecal incontinence associated with it. I do not have either type of incontinence.

    Neither the Dellon, nor the Marvel, nor the Prologo discussions anywhere available on the internet mention incontinence as a criteria for a pudendal neuralgia diagnosis.

    Do you, Sara, or any of your readers/ commentors have thoughts or experience on this?

    1. Hi Stacie,

      Interesting comment you have. I do not see fecal or urinary incontinence as an absolute with pudendal neuralgia.

      Sara

    2. Hi Stacy.

      First, I am very sorry for your PN difficulty. Stay strong and keep pushing to find the right treatment for you!

      I have met with Dr. Dellon, and I am a current patient of Dr. Marvel’s since Aug 2016. I can attest that for both of them, urinary/fecal incontinence is NOT a criteria for Pudendal Neuralgia. I do not suffer from either, and my diagnosis was confirmed by both Dr. Dellon and Dr. Marvel. Incontinence is, however, one of the symptoms PN can elicit, but it is not a diagnosis requirement. I personally have rectal spasms triggered by bowel movements, but that is also not a requirement for the diagnosis. Of all the physicians I have seen for PN, the consensus has been that a CT guided nerve block is the definitive diagnostic tool.

      Also, Dr. Prologo is by no means the only interventional radiologist performing CT guided Pudendal Nerve Cryoablasion, and general results are not as positive as what he is experiencing with his patients. I saw interventional radiology at Johns Hopkins Hospital in Baltimore, and my cryoablasion made my condition worse. This is apparently the case with many patients, and has become a topic of debate among pelvic pain specialists as to whether this is an appropriate steps for people suffering from PN. There are also many people who get relief, but have to repeat the process again and again as the nerve grows back.

      I hope you find relief.

  10. Alas, I have attempted to contact Dr. Prologo twice via email. Unfortunately, he has not replied. Fortunately, I have Health Advocate through work and they will hopefully get my records and arrange everything. The nagging fear I have is that he may not treat me because I was (I believe) misdiagnosed with IC in the beginning. I have pain along the nerve paths that lead through the Pelvic floor (as per the article “How Do I Know If I Have PN Or PNE”). I can apply pressure to the area between my anus and left ischial tuberocity and get relief from the pain. Wouldn’t that indicate nerve-based pain and not IC?

    1. Hi Neil,

      I can’t speak on Dr. Prologo’s behalf, but I hope that all doctors do their own assessment. Many people are misdiagnosed with IC and I think that many physicians are aware that this is happening. I’m not saying you do or do not have IC, but I will say that it’s very good that you can find a spot that relieves your pain. Often that is from a pelvic floor muscle issue.

      Sara

  11. Hi Stacie,

    Your doctors are not entirely incorrect. Pudendal Nerve does impact fecal… It anus track contracts and causes those issues although this isn’t an absolute. You can have PN with more of these issues.

    Raj

    1. Hello Raj,

      I am in Florida. All my doctors–GP, neurologist, urologist, gynecologists ( I have several gynecologists)–look horrified when I explain the cryoablation treatment to them. The neurologist I met with last week actually turned pale and scooted her chair back away from me.

      They all think the cryoabalation will cause fecal and/or urinary incontinence. My pelvic pain physical therapists say they see pudendal neuralgia patients who are not incontinent.

      I hope to press one of my gynecologists into writing a letter of referral for a consult later this month.

      The problem that I am running into is that none of the 9 *nine* doctors I am working with here in Florida will utter the words ” pudendal neuralgia”. Apparently, because nerve conductivity tests, at least here, are not done for PN patients, no one feels able to give a firm diagnosis of PN. The Univ of Florida med school doctor who did the nerve conductivity tests on me for paraesthesia said he used to do them at U Rochester but eventually refused because they were so very painful for the patients.

      So– no firm diagnosis of PN because no one will test…etc. It’s maddening.

      I hope people will keep posting about their experiences with Dr. Prologo so that the rest of us can perhaps use the information to work with our doctors.

  12. I still can’t find any testimonials for Dr. Prologo’s cryo treatment here or elsewhere online. Would love to hear from anyone, good or bad experience.

  13. I have PN as determined by block at Alcock’s Canal. Cryo did not work for me. Others have gotten worse. A few have gotten better. You need to weigh the risks and benefits.

  14. 56 yr old male. Went and had the cryoablation procedure done on February 24th, 2017. Oddly, they would not give me the success rate of the procedure over the phone, but insisted I come down from NJ to ask that question in person. Red flag? I can find nothing negative about this man online and he is as affable and friendly in person as his picture would suggest. I was told that results fall into thirds. One third get instant relief, one third take 2-3 months to experience relief and one third get no reiief. A month in and my symptoms are the same if not a bit worse! I am praying that this is just normal and that the money spent and traveling were not in vain. I only seem to get relief from drugs in the diazopenes family. Seeing a psychiatrist. Currently taking Valium. It’s taking what I consider to be staggering 40 mg to get pain relief! Yesterday I took a fifth one in the evening! April 13th is my next appointment. I think I am going to have to try Lyrica, which scares me because they mention the risk of difficulty breathing and I almost died of anaphylactic shock some years back.

    1. Hi, I’m sorry to read about your struggle. Do you have pudendal nerve entrapment? My dad does and cant seem to get relief from the pain. All the nerve blocks and ablations have made the pain worse. We do not know where to guide him for pain relief help.

      It is now June. Have you had anymore treatments or relief in pain?
      -Allison

    2. Greetings Neil! I hate that you have suffered so terribly! I’m encouraged by your strength to endure & keep fighting. We must not give up on YOU! Most will never understand our debilitating & wicked pain. Please, how are you currently fairing? I recently discovered this site & I am seriously contemplating a visit & hopefully to receive the procedure by this physician. Suffered long enough! I appreciate your candid comment & look forward to your reply.

      ~Tess

    3. Neil, wanted to check to see how you’re doing? I’m scheduled to see Dr. Prologo later this month for ilioinguinal nerve pain.

      1. Kendra, I was wondering if you saw Dr. Prologo for the ilioinguinal pain. I had cryoablation for ilioinguinal and genitofemoral nerve with him December 2016. I had good pain relief for about 5 months, unfortunately the pain has returned. If you had the cryoablation did you get any relief?

  15. One of the ladies in my support group was 100% cured of Pudendal Neuralgia through Dr. Prologo.
    She has since left the support groups and Facebook, so I do not know how she is doing now. It’s been about 2 years. Sorry I can’t tell you more.

  16. I had Pudendal nerve cryoablasion with interventional radiology at Johns Hopkins Hospital in Baltimore, who has been performing this procedure for a few years. The statistics I was informed prior to the procedure had about 70% of patients had some pain relief, although it could take up to 3 months to feel the effects, and pain can come within a year or two. My personal experience was an increase of PN symptoms after the cryoablasion. I had another cryo after 5 months, and although the second procedure helped, my pain and spasms were still worse than they were before the first one. Now I see Dr. Marvel in Maryland, and just recently had an internal peripheral nerve stimulator (Neuromodulation) placed right on the Pudendal nerve. Let me tell you, it is amazing the results you get with this thing. The stimulator helps with pain, spasms and urinary/fecal incontinence, and it is a great option for a lot of PN patients.

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