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BACKGROUND:Pudendal neuralgia (PN) is a chronic condition causing persistent genital and rectal pain. While pudendal nerve blocks offer temporary relief, their effects are often short-lived. When nerve blocks fail, radiofrequency neurotomy (RFN) may be an alternative treatment. This study evaluates the outcomes of fluoroscopy-guided thermal or pulsed RFN in patients with transient relief from nerve blocks. METHODS:This retrospective cohort study included 8 patients with PN who had received a fluoroscopy-guided transgluteal pudendal nerve block but experienced < 2 weeks of relief. CASE REPORTS/METHODS:Patients underwent fluoroscopy-guided transgluteal RFN (thermal or pulsed). Seven patients treated with pulsed RFN experienced ≥ 50% pain relief, lasting 29 to 152 days. One patient treated with thermal RFN had multiple treatments, achieving pain relief ≤ 1 months. Patients also reported significant functional improvements. CONCLUSIONS:Fluoroscopy-guided transgluteal thermal and pulsed RFN shows promise for patients with limited relief from nerve blocks.