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

Evaluation and management of chronic anorectal and pelvic pain syndromes: Italian Society of Colorectal Surgery (SICCR) position statement

Chronic pelvic pain is a hidden issue which needs to involve many different usually uncoordinated specialists. For this reason there is a risk that treatments, in the absence of well-defined pathways, common goals, and terminology, may be poorly effective. The aim of the present paper is to summarize the evidence on anorectal pelvic pain, offering useful evidence-based practice parameters for colorectal surgeons' daily activity. Analysis of chronic anorectal and pelvic pain syndromes, the diagnostic and clinical optimal needs for evaluation, and the innumerable low evidence treatments and therapeutic options currently available suggests that a multimodal individualized management of pain may be the most promising approach. The limited availability of dedicated centers still negatively affects the applicability of these principles.

Current position of neuromodulation for bladder pain syndrome/interstitial cystitis

PURPOSE OF REVIEW

Despite established effectiveness in overactive bladder and nonobstructive retention, neuromodulation's application in interstitial cystitis/bladder pain syndrome (IC/BPS) remains a topic of ongoing research. The purpose of this article is to review recent developments in neuromodulation as treatment of IC/BPS offering guidance for healthcare practitioners dealing with IC/BPS cases.

RECENT FINDINGS

Recent research underlines the promising role of sacral, tibial and pudendal neuromodulation in management of IC/BPS symptoms. Studies reveal encouraging outcomes, particularly in alleviating urgency and frequency symptoms. However, while urgency and frequency symptoms tend to improve, comprehensive pain relief remains a challenge. Percutaneous tibial nerve stimulation (PTNS) and transcutaneous tibial nerve stimulation (TTNS) stand out due to their minimal invasive nature. Existing literature points to the need for larger prospective studies with extended follow-up periods to validate the efficacy and sustainability of neuromodulation.

SUMMARY

Neuromodulation is a promising treatment modality for refractory IC/BPS. Due to the minimal invasive nature, they should be tried before rigorous surgery. However, the limited quantity of available data and the variability in pain relief outcomes necessitate cautious interpretation. The review emphasizes the need for further research.

Neuromodulation Techniques in Chronic Refractory Coccydynia: A Narrative Review

Refractory coccydynia is a condition characterized by severe coccygeal pain and poses a challenging management dilemma for clinicians. Advancements in neuromodulation (NM) technology have provided benefits to people experiencing chronic pain that is resistant to standard treatments. This review aims to summarize the spectrum of current NM techniques employed in the treatment of refractory coccydynia along with their effectiveness. A review of studies in the scientific literature from 2012 to 2023 was conducted, revealing a limited number of case reports. Although the available evidence at this time suggests significant pain relief with the utilization of NM techniques, the limited scope and nature of the studies reviewed emphasize the need for large-scale, rigorous, high-level research in this domain in order to establish a comprehensive understanding of the role of NM and its effectiveness in the management of intractable coccydynia.

Real-life after sacral nerve modulation implantation: Rate, reasons, and risk factors for mid-term follow-up discontinuation

OBJECTIVES

To evaluate follow-up after implantation of a sacral nerve modulation implantable pulse generator (IPG) and to investigate the reasons and risk factors for follow-up discontinuation.

MATERIALS AND METHODS

All patients who underwent an IPG implantation to treat lower urinary tract symptoms between 2014-2019 within 6 hospital centers located in the district of "Hauts-de-France" (France) were systematically called during the year 2020 for a standardized (tele)consultation. Patients were divided into 3 distinct profiles according to the regularity of their 5-year postoperative follow-up: "Regular follow-up", "Irregular follow-up" and "Lost to follow-up". The primary outcome was the change in the annual proportion of the 3 follow-up profiles over the 5 years following IPG implantation. As secondary outcomes we described the reasons reported for follow-up discontinuation and looked for risk factors associated with.

RESULTS

Overall, 259 patients were included. At the time of data collection, after a mean follow-up of 28.4 (± 19.8) months, 139 patients (53.7%) had a "Regular follow-up", 54 (20.8%) had an "Irregular follow-up" and 66 (25.5%) were "Lost to follow-up". The proportion of patients with a "Regular follow-up" decreased year by year, representing only 46.2% of patients at five-years. 175 patients (67.6%) underwent a standardized (tele)consultation. In multivariate analysis, only "lack of knowledge of the follow-up protocol" was statistically associated with follow-up discontinuation (OR=5.16; 95% CI [2.12-13.57]).

CONCLUSION

The proportion of patients followed up after IPG implantation decreased steadily over the years, often related to a lack of therapeutic education.

LEVEL OF EVIDENCE: 4

Chronic Penile Pain: A Poorly Researched and Managed Life-Debilitating Condition

Chronic penile pain is a complex clinical entity with limited diagnostic criteria and treatment options. Due to limited reporting of these cases, there are no clear clinical treatments and indications for when these patients present to the clinic. This case report will highlight the diagnostic challenges encountered and the subsequent management strategies employed while working up a patient with penile pain. We present a 37-year-old male with a six-year history of debilitating penile pain, urinary frequency, and urgency that is exacerbated by sexual arousal and touch. Initial evaluations attributed the symptoms to medication side effects, leading to medication changes. Despite multiple treatments, including gabapentin, solifenacin, vibegron, and a variety of specialist consultations, the patient's condition persisted. Neurological evaluation revealed pudendal neuropathy. Medical management with pudendal nerve blocks and gabapentin did not provide lasting relief, so surgical interventions were considered. Subsequent treatment with an InterStim II device (Medtronic Inc., Minneapolis, MN) initially resulted in significant symptom improvement. Unfortunately, at the seven-month follow-up, his pain returned. Further evaluation and additional treatment options are currently under consideration. This case report highlights the diagnostic complexity and limited treatment options for chronic penile pain. It suggests that sacral neuromodulation, although lacking long-term data, may offer temporary relief in cases refractory to medical therapy. Further research is needed to enhance our understanding and management of this challenging condition.