Outcomes of sacral neuromodulation for chronic pelvic pain: a Finnish national multicenter study

Abstract

Background The aim of this study was to report the outcomes of sacral neuromodulation (SNM) in chronic pelvic pain (CPP) patients in the Finnish national cohort. Methods This was a register-based retrospective study, involving all the centers that provide SNM treatment in Finland. The data of all patients treated with SNM for CPP were gathered from Oulu-, Turku-, Tampere-and Helsinki University Hospitals, as well as Jyväskylä and Seinäjoki Central Hospitals. All patients who had been tested for SNM implantation prior to April 2017 were included in the study. Results A total of 51 patients were selected for SNM treatment due to CPP from 2004 until 2017. The mean follow-up time was 13.8 months (SD 22.9 months). A total of 28 patients (57%) advanced from testing to permanent stimulator implantation. There were 21 patients (41%) who had a working modulator implanted at the end of follow-up. Patients with endometriosisrelated pain had a significantly higher permanent implantation rate than the overall implantation rate (88% vs. 57%; p = 0.01). The endometriosis patients also had a higher overall success rate by the end of the follow-up (75% vs. 41%; p = 0.026) Conclusions SNM may be a viable treatment option for patients with CPP due to endometriosis. Further research on SNM treatment for endometriosis patients with refractory CPP is needed.

Sacral neuromodulation in the management of chronic pelvic pain: A systematic review and meta‐analysis

“…The WMD in pain score on a 10‐point scale after SNM was −4.64 (95% CI = −5.32 to −3.95, p < 0.00001) (Figure 2). Six studies were excluded from quantitative analysis as they did not report mean ± SD VAS 14,21,26,28–30 . Three of these studies reported a significant decrease in pain score after SNM ( p < 0.05).…”

“…Six studies were excluded from quantitative analysis as they did not report mean ± SD VAS. 14,21,26,[28][29][30] Three of these studies reported a significant decrease in pain score after SNM (p < 0.05). The remaining three reported a decrease in pain score but did not perform statistical analysis (Supporting Information: Appendix).…”

Medium-term outcomes of sacral neuromodulation in patients with refractory overactive bladder: A retrospective single-institution study

“…The exact mechanism of action of SNM is unknown, however, it is believed to correct the balance between the peripheral sacral nerves and the central nervous system by stimulating the afferent sensory fibers of the pelvic and pudendal nerves [18]. Following its approval, SNM has been increasingly utilized for OAB, and the evidence base for its medium to long-term (3 plus years) safety and efficacy is gradually building up [19][20][21][22][23][24][25][26]. However, the majority of the existing literature has been funded by the SNM device manufacturer [21,[24][25][26][27][28][29].…”

Spinal Cord Stimulation of the Sacral Region as a Treatment for Intractable Coccygodynia: A Case Study

“…Based on evidence, the sacral portion of the spinal cord is the ideal site for neuromodulation in the treatment of CPP caused by different etiologies (19,22,23). CPP encompasses a number of treatment-resistant conditions including irritable bowel syndrome, interstitial cystitis, pudendal neuralgia, and coccygodynia (24).…”

“…Sacral neuromodulation (SNM) is one approach that has conventionally been used to manage overactive bladder, nonobstructive urinary retention, and fecal incontinence (25). SNM and SCS have shown success in the treatment of CPP (19,22,23,(26)(27)(28)(29)(30). Zabihi et al (29) reported positive results from SNM via a retrograde approach over S2-S4 for the treatment of refractory CPP, interstitial cystitis, and painful bladder pain syndrome.…”