Short-term results of bilateral S2–S4 sacral neuromodulation for the treatment of refractory interstitial cystitis, painful baldder syndrome, and chronic pelvic pain

Abstract

We evaluated the efficacy of bilateral caudal epidural sacral neuromodulation for the treatment of refractory chronic pelvic pain (CPP), painful bladder syndrome, and interstitial cystitis (IC). Thirty consecutive patients (21 female, 9 male) with severe refractory symptoms underwent bilateral S2-S4 sacral neuromodulation for CPP/IC. Patients were evaluated with the O'Leary IC symptom and problem index (ICSI, ICPI), the short form of the Urogenital Distress Inventory (UDI-6), and the RAND 36-item health survey (SF-36) preoperatively and 6 months postoperatively. The mean and minimum follow-up were 15 and 6 months, respectively. Of the 30 patients, 23 (77%) had a successful trial stimulation and were permanently implanted. Among these patients, the ICSI and ICPI scores improved by 35 (p = 0.005) and 38% (p = 0.007), respectively. The pain score improved by 40% (p = 0.04) and the UDI-6 score by 26% (p = 0.05). On average, patients reported a 42% improvement in their symptoms. SF-36 scores did not improve significantly. In refractory patients, bilateral caudal epidural sacral neuromodulation is another possible mode of treatment, which appears to improve both pelvic pain and voiding symptoms.

CUA guideline: Diagnosis and treatment of interstitial cystitis/ bladder pain syndrome

“…189,192,193,195 Peters et al 192 found a statistically significant decrease in narcotic use postoperatively (from 81.6 to 52 mg/day injectable morphine equivalents, p=0.015) with 4/18 patients stopping narcotic use completely.…”

“…No RCTs have been completed to assess the effect of SNM on symptoms of IC/BPS. However, multiple observational studies have been reported, [188][189][190][191][192][193][194][195] including long-term followup of 86 ± 9.8 months. 191 All studies include patients refractory to multiple IC/BPS treatment options.…”

Pelvic pain in urogynecology. Part II: treatment options in patients with lower urinary tract symptoms

“…Twelve report on the treatment of pelvic pain and LUTS using sacral, pudental and tibial nerve stimulation [8][9][10][11][12][13][14][15][16][17][18][19]. Table 1 shows the published articles in the order of date of publication.…”

Animal models of sacral neuromodulation for detrusor overactivity

“…More recently, this technique has displayed a certain degree of efficacy in the treatment of chronic urine retention and in painful bladder syndrome or chronic pelvic pain. 3,4 Numerous theories have been put forward to explain the mechanism of action, but the underlying biological mechanisms are still subject of controversy. 5 …”