1
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Kendall HJ, Schrijvers J, Heesakkers JP. Current position of neuromodulation for bladder pain syndrome/interstitial cystitis. Curr Opin Urol 2024; 34:64-68. [PMID: 37933670 PMCID: PMC10842653 DOI: 10.1097/mou.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
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.
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Affiliation(s)
- Harry J. Kendall
- Department of Urology, Maastricht University Medical Centre
- Maastricht University, Maastricht, The Netherlands
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2
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Bieze M, van Haaps AP, Kapural L, Li S, Ferguson K, de Vries R, Schatman ME, Mijatovic V, Kallewaard JW. Spinal Cord Stimulation for Intractable Visceral Pain Originating from the Pelvic and Abdominal Region: A Narrative Review on a Possible New Indication for Patients with Therapy-Resistant Pain. J Pain Res 2024; 17:691-736. [PMID: 38405684 PMCID: PMC10887953 DOI: 10.2147/jpr.s445616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/03/2024] [Indexed: 02/27/2024] Open
Abstract
Aim Visceral pain, characterized by pain that is diffuse and challenging to localize, occurs frequently and is difficult to treat. In cases where the pain becomes intractable despite optimal medical management, it can affect patients' Quality of Life (QoL). Spinal Cord Stimulation (SCS) has emerged as a potential solution for intractable visceral pain. Purpose In this narrative review, we collected all evidence regarding the efficacy of SCS for visceral pain across various underlying conditions. Methods A comprehensive literature search was conducted in PubMed, Embase, and Web of Science in which articles published from October 1st, 1963 up to March 7th, 2023 were identified. Results Seventy articles were included in this review of which most were retrospective cohort studies, case series and case reports. The studies, often with a small number of participants, reported on SCS for chronic pancreatitis, anorectal pain and bowel disorders, gynaecological diagnoses, visceral pelvic pain, urological disorders and finally general visceral pain. They found positive effects on pain and/or symptom relief, opioid consumption, anxiety and depression and QoL. Complications occurred frequently but were often minor and reversible. Conclusion Better screening and selection criteria need to be established to optimally evaluate eligible patients who might benefit from SCS. A positive outcome of a sympathetic nerve block appears to be a potential indicator of SCS effectiveness. Additionally, women receiving SCS for endometriosis had a better outcome compared to other indications. Finally, SCS could also relief functional symptoms such as voiding problems and gastroparesis. Complications could often be resolved with revision surgery. Since SCS is expensive and not always covered by standard health insurance, the incorporation of cost-analyses is recommended. In order to establish a comprehensive treatment plan, including selection criteria for SCS, rigorous prospective, possibly randomized and controlled studies that are diagnosis-oriented, with substantial follow-up and adequate sample sizes, are needed.
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Affiliation(s)
- Matthanja Bieze
- Department of Anesthesiology and Pain Management, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Annelotte Pauline van Haaps
- Department of Reproductive Medicine, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Leonardo Kapural
- Carolina’s Pain Institute and Center for Clinical Research, Winston Salem, North Carolina, USA
| | - Sean Li
- National Spine and Pain Centers, Shrewsbury, New Jersey, USA
| | - Kris Ferguson
- Aspirus Langlade Hospital Pain Clinic, Antigo, Wisconsin, USA
| | - Ralph de Vries
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA
- Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Velja Mijatovic
- Department of Reproductive Medicine, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Jan Willem Kallewaard
- Department of Anesthesiology and Pain Management, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Anesthesiology and Pain Management, Rijnstate Ziekenhuis, Arnhem, the Netherlands
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3
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Hao D, Yurter A, Chu R, Salisu-Orhurhu M, Onyeaka H, Hagedorn J, Patel K, D'Souza R, Moeschler S, Kaye AD, Orhurhu V. Neuromodulation for Management of Chronic Pelvic Pain: A Comprehensive Review. Pain Ther 2022; 11:1137-1177. [PMID: 36109459 PMCID: PMC9633896 DOI: 10.1007/s40122-022-00430-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/26/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Chronic pelvic pain (CPP) is a symptom that derives from a complex group of heterogeneous pathologies of the pelvic organs. The aim of this study was to review the available evidence on efficacy of neuromodulatory modalities including sacral neuromodulation, dorsal root ganglion stimulation, dorsal column neuromodulation, and pudendal nerve stimulation. METHODS This narrative review focuses on updated information on neuromodulation for management of chronic pelvic pain. In 2022, we searched English-language studies on neuromodulation, pelvic pain, and chronic pain in a comprehensive search. We searched the following databases: PubMed, Medline, SciHub, Cochrane Database of Systematic Reviews, and Google Scholar. We used the following combinations of keywords: neuromodulation, pelvic pain, chronic pain, chronic pelvic pain, pelvic pain treatment. We tried to include as many recent manuscripts as possible (within the last 3 years) but also included papers older than 3 years if they were particularly relevant to our topic. We also attempted to search for, use, and cite primary manuscripts whenever possible. RESULTS CPP is a challenging entity to treat because of diagnostic inconsistencies and limited evidence for therapeutic modalities. Our review found evidence suggestive of benefit for all modalities reviewed but the data was of overall low quality with numerous limitations. The literature highlights a lack of randomized controlled trials for neuromodulatory therapies but suggests a growing role for such techniques in treating refractory chronic pelvic pain syndrome (CPPS). CONCLUSIONS This review explores the available evidence on efficacy of neuromodulatory modalities for CPPS and contextualizes the results with information about the type of neuromodulation, lead location and waveform, pain outcomes and assessment timepoints, and reported adverse effects.
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Affiliation(s)
- David Hao
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alp Yurter
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Chu
- Department of Anesthesiology, Duke University, Durham, NC, USA
| | - Mariam Salisu-Orhurhu
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
- MVM Health, East Stroudsburg, PA, USA
| | - Henry Onyeaka
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Kiran Patel
- Department of Anesthesiology, New York University Langone Medical Center, New York City, NY, USA
- Department of Anesthesiology and Pain Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
| | - Ryan D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Susan Moeschler
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alan David Kaye
- Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU School of Medicine, Shreveport, LA, USA
- Anesthesiology and Pharmacology, LSU School of Medicine, New Orleans, LA, USA
- Anesthesiology and Pharmacology, Tulane School of Medicine, New Orleans, LA, USA
| | - Vwaire Orhurhu
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA.
- MVM Health, East Stroudsburg, PA, USA.
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4
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Xiang H, Zhang T, Al-Danakh A, Yang D, Wang L. Neuromodulation in Chronic Pelvic Pain: A Narrative Review. Pain Ther 2022; 11:789-816. [PMID: 35834103 PMCID: PMC9314476 DOI: 10.1007/s40122-022-00405-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/14/2022] [Indexed: 01/11/2023] Open
Abstract
Chronic primary pelvic pain syndrome (CPPPS) is a heterogeneous disease with unknown pathogenesis and a lack of distinct pathological features, which complicates diagnosis and therapy and has a significant impact on patients' daily life. Because pharmacological management is ineffective and long-term use may result in additional system damage, developing a more effective treatment is critical. Neuromodulation has advanced rapidly over the last few decades, and various types of neuromodulations have demonstrated efficacy in the treatment of CPPPS. In this article we discuss the evolution of neuromodulation technology in the treatment of chronic pelvic pain, its application to various subtypes of chronic pelvic pain, and the comparison of relevant efficacy and parameter differences, as well as assess the relative advantages and disadvantages of sacral neuromodulation, percutaneous tibial nerve stimulation , transcutaneous electrical nerve stimulation, electroacupuncture, and pudendal neuromodulation. Furthermore, it was noted that chronic pelvic pain should be evaluated in terms of pain, associated symptoms, psychological problems, and quality of life. Although neuromodulation approaches have been shown to be effective in treating chronic pelvic pain, more extensive multicenter trials are required to confirm this.
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Affiliation(s)
- Hao Xiang
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian, 116021, China
| | - Tingting Zhang
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian, 116011, China
| | - Abdullah Al-Danakh
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian, 116021, China
| | - Deyong Yang
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian, 116021, China.
- Healinghands (Dalian) Clinic, Dalian, Liaoning, China.
| | - Lina Wang
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian, 116021, China.
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5
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Ajimsha MS, Ismail LA, Al-Mudahka N, Majzoub A. Effectiveness of external myofascial mobilisation in the management of male chronic pelvic pain of muscle spastic type: A retrospective study. Arab J Urol 2021; 19:394-400. [PMID: 34552791 PMCID: PMC8451701 DOI: 10.1080/2090598x.2021.1954414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objective To evaluate the outcome of men with muscle spastic chronic pelvic pain syndrome (CPPS) who underwent a comprehensive five-session fascial connectivity based external myofascial mobilisation (EMM) approach. Patients and methods A retrospective chart review of patients who underwent EMM for CPPS at the Pelvic Pain Unit of Hamad Medical Corporation, Qatar between January 2019 and October 2020 was conducted. Patient's symptoms were measured with the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) scale and the numerical rating scale (NRS) before and after the completion of the sessions. The patients were given five EMM sessions as a 'once-a-week' programme. Results A total of 31 patients who completed all the EMM sessions were included. The mean (range) age of patients was 38 (20-54) years. The mean (SD) NIH-CPSI score at initial evaluation was 29.41 (8.3) and decreased to 9.14 (3.45) after the fifth visit. All the patients in the study group had a reduction of >6 points in the NIH-CPSI score, indicating a robust treatment response. The NRS reading also revealed significant improvement in pain (P < 0.001). Conclusions : An EMM approach based on fascial connectivity led to significant symptom improvement in all the studied patients. EMM may be an effective treatment option for muscle spastic type of CPPS. Future high-quality studies with control groups are needed to confirm the present findings. Durability and long-term results are yet to be determined. ABBREVIATIONS CP/CPPS: chronic prostatitis/chronic pelvic pain syndrome; EMM: external myofascial mobilisation; EO: external oblique; FM: fascial manipulation; GMx: gluteus maximus; HAC: hip adductor complex; HMC: Hamad Medical Corporation; IO: internal oblique; LD: latissimus dorsi; MFR: myofascial release; MM: myofascial mobilisation; NIH-CPSI: National Institute of Health-Chronic Prostatitis Symptom Index; NRS: numerical rating scale; PFPT: pelvic floor physical therapy; QoL, quality of life; TLF: thoracolumbar fascia; UPOINT: urinary (U), psychosocial (P), organ-specific (O), infection (I), neurological/systemic (N) and tenderness of pelvic floor skeletal muscles (T).
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Affiliation(s)
- M S Ajimsha
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar
| | | | - Noora Al-Mudahka
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medicine - Qatar, Doha, Qatar
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6
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Mass-Lindenbaum M, Calderón-Pollak D, Goldman HB, Pizarro-Berdichevsky J. Sacral neuromodulation - when and for who. Int Braz J Urol 2021; 47:647-656. [PMID: 33621015 PMCID: PMC7993957 DOI: 10.1590/s1677-5538.ibju.2021.99.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/10/2020] [Indexed: 01/14/2023] Open
Affiliation(s)
| | | | - H B Goldman
- Glickman Urologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Javier Pizarro-Berdichevsky
- Centro de Innovación en Piso Pélvico, Hospital Sótero del Río, Santiago, Chile.,Division de Obstetricia y Ginecología, Hospital Sótero del Río, Pontificia Universidad Católica de Chile, Santiago, Chile
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7
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Gandhi S, Gajewski JB, Koziarz A, Almutairi S, Ali A, Cox A. Long-term outcomes of sacral neuromodulation for lower urinary tract dysfunction: A 23-year experience. Neurourol Urodyn 2020; 40:461-469. [PMID: 33232534 DOI: 10.1002/nau.24583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 11/09/2022]
Abstract
AIMS To evaluate the long-term outcomes of sacral neuromodulation (SNM), and patient characteristics that may predict long-term success or complications. METHODS A single-center retrospective cohort study was performed of all patients who underwent SNM testing and implantation. Outcome results, resolution of symptoms, and device removal were reported. Multivariable logistic regression was used to identify predictors of success. Cox proportional hazards model was used to identify predictors for device removal. RESULTS Four hundred and thrity four patients underwent SNM test phase of which 241 (median age 48.0 years, 91.7% [221/241] female) had device implantation and were followed up for median [range] time of 4.0 (3 months-20.5 years) years. Multivariable logistic regression showed that male gender (odds ratio: 0.314; 95% confidence interval: 0.164-0.601, p = .0005) was independently associated with decreased peripheral nerve evaluation success. At final follow-up for patients who originally had device implantation, median (interquartile range) percent of symptoms resolution of all patients was 60.0% (0%-90%) and 69.3% (167/241) had SNM successful outcomes. Cox proportional hazards model showed no difference for time to SNM device removal with respect to patient age, gender, or diagnosis. 69.3% (167/241) patients had at least 1 surgical re-intervention. The most common reason at first surgical re-intervention was lead change only (26.3%, 44/167). CONCLUSION SNM is a minimally invasive procedure with good long-term success rates. There is a high revision rate but overall, SNM has a good safety profile and excellent long-term outcomes.
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Affiliation(s)
- Shreyas Gandhi
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jerzy B Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alex Koziarz
- Division of Urology, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sulaiman Almutairi
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Abdullah Ali
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
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8
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Kaaki B, Gupta D. Medium-term outcomes of sacral neuromodulation in patients with refractory overactive bladder: A retrospective single-institution study. PLoS One 2020; 15:e0235961. [PMID: 32645082 PMCID: PMC7347151 DOI: 10.1371/journal.pone.0235961] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 06/26/2020] [Indexed: 01/14/2023] Open
Abstract
Background Sacral neuromodulation (SNM) is a minimally invasive fully reversible therapy that was approved in 1997 for overactive bladder syndrome (OAB) refractory to behavior modification and pharmacotherapy. Despite being in use for over two decades, the data on medium to long-term safety and efficacy of SNM in OAB is limited. We investigated the medium-term efficacy and safety of SNM along with the predictive factors for its success in patients with refractory OAB. Methods A retrospective consecutive case series of 66 patients undergoing SNM for refractory OAB between July 2009 and July 2018. All patients underwent a test period followed by permanent implantation, if there was > = 50% improvement in any symptom. The primary outcome was “success” defined as > = 50% improvement in any clinical parameter based on the subjective assessment of patient’s response. The secondary outcomes were number of pads used in 24 hours, post-operative complications and re-operation rates. Results 66 females with an average age of 62.7 years were included. 55/66 patients (83.3%) had a successful test phase and underwent permanent implantation. After a median follow-up of 32 months, SNM was successful in 41/55 (74.5%) patients. Mean number of pads used in 24 hours decreased significantly from 3.5 preoperatively to 1.2 at last follow-up (p<0.001). 8/55 (14.5%) patients reported complications of pain, lead migration, wound dehiscence and device malfunction. 10/55 (18.2%) patients underwent revision surgeries after a median duration of 21.9 months. Device was explanted in 15/55 (27.3%) patients after a median duration of 24 months. No significant predictor for success was identified. Conclusions The success rate of SNM is 75% with a complication rate of 14.5% after a median follow-up of ~3 years. This study suggests medium-term efficacy and safety but a high re-operation rate of SNM in patients with refractory OAB.
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Affiliation(s)
- Bilal Kaaki
- Des Moines University, Des Moines, Iowa, United States of America
- Department of Obstetrics and Gynecology, UnityPoint Health, Waterloo, Iowa, United States of America
- * E-mail:
| | - Digant Gupta
- Clin-Science Research Consulting, Chicago, Illinois, United States of America
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9
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10
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Sacral Neuromodulation in the Management of Bladder Pain Syndrome/Interstitial Cystitis. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00579-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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Cottrell AM, Schneider MP, Goonewardene S, Yuan Y, Baranowski AP, Engeler DS, Borovicka J, Dinis-Oliveira P, Elneil S, Hughes J, Messelink BJ, de C Williams AC. Benefits and Harms of Electrical Neuromodulation for Chronic Pelvic Pain: A Systematic Review. Eur Urol Focus 2020; 6:559-571. [PMID: 31636030 DOI: 10.1016/j.euf.2019.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 09/04/2019] [Accepted: 09/17/2019] [Indexed: 12/12/2022]
Abstract
CONTEXT Patients with chronic pelvic pain (CPP) may have pain refractory to conventional pain management strategies. Neuromodulation could provide relief of pain. OBJECTIVE To evaluate the benefits and harms of neuromodulation for CPP. EVIDENCE ACQUISITION A comprehensive search of EMBASE, PUBMED, and SCOPUS was performed for the entire database to January 2018. Studies were selected, data were extracted, and quality was assessed by two independent reviewers. A meta-analysis was used to combine randomized controlled trials (RCTs); otherwise, a narrative analysis was used. EVIDENCE SYNTHESIS After screening 1311 abstracts, 36 studies including eight RCTs were identified, enrolling 1099 patients. Studies covered a broad range in terms of phenotypes of CPP and methods of neuromodulation. A meta-analysis was possible for percutaneous tibial nerve stimulation and transcutaneous electrical nerve stimulation, which showed improvement in pain. Only narrative synthesis was possible for other modalities (sacral nerve stimulation, spinal cord stimulation, intravaginal electrical stimulation, and pudendal nerve stimulation) which appeared to reduce pain in patients with CPP. Treatments generally improved quality of life but with variable reporting of adverse events. Many studies showed high risks of bias and confounding. CONCLUSIONS While electrical neuromodulation may improve symptoms in CPP, further work is needed with high-quality studies to confirm it. PATIENT SUMMARY Neuromodulation may be useful in reducing pain and improving quality of life in patients with chronic pelvic pain, but more research is needed.
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Affiliation(s)
| | | | | | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Andrew P Baranowski
- University College London and University College Hospital and the National Hospital for Neurology and Neurosurgery, London, UK
| | | | | | | | - Sohier Elneil
- National Hospital for Neurology and Neurosurgery, London, UK
| | - John Hughes
- The James Cook University Hospital, Middlesbrough, UK
| | - Bert J Messelink
- Department of Urology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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12
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Marinkovic SP. Improving clinical outcomes with lower motor voltage (≤3 V) during stage 1 sacral neuromodulation for interstitial cystitis or bladder pain syndrome. Neurourol Urodyn 2019; 38:2233-2241. [DOI: 10.1002/nau.24123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/03/2019] [Indexed: 12/27/2022]
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13
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Mahran A, Baaklini G, Hassani D, Abolella HA, Safwat AS, Neudecker M, Hijaz AK, Mahajan ST, Siegel SW, El-Nashar SA. Sacral neuromodulation treating chronic pelvic pain: a meta-analysis and systematic review of the literature. Int Urogynecol J 2019; 30:1023-1035. [PMID: 30874835 DOI: 10.1007/s00192-019-03898-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/05/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Sacral neuromodulation (SNM) is gaining popularity as a treatment option for chronic pelvic pain (CPP). Our hypothesis is that SNM is effective in improving CPP. METHODS A systematic search was conducted through September 2018. Peer-reviewed studies using pre- and postpain intensity scores were selected. The primary outcome was pain improvement on a 10-point visual analog scale (VAS) (adjusted or de novo) in patients with CPP. Secondary outcomes included comparing SNM approaches and etiologies and evaluating lower urinary tract symptoms (LUTS). RESULTS Fourteen of 2175 studies, evaluating 210 patients, were eligible for further analysis. The overall VAS pain score improvement was significant [weighted mean difference (WMD) -4.34, 95% confidence interval (CI) = -5.22, to-3.64, p < 0.0001)]. Regarding SNM approach, both standard and caudal approaches had significant reduction in pain scores: WMD -4.32, CI 95% = -5.32, to -3.31 (p < 0.001) for the standard approach, compared with WMD -4.63, 95% CI = -6.57 to -2.69 (P < 0.001), for the caudal approach (p = 0.75). While significant improvement in pain was observed both in patients with and without interstitial cystitis/bladder pain syndrome (IC/BPS), the observed improvement was lower in patients with (WMD -4.13, CI 95% -5.36 to -2.90 versus without (WMD -5.72, CI 95% = -6.18, to-5.27) IC/BPS (p = 0.02). SNM was effective in treating voiding symptoms (frequency, urgency, nocturia) associated with IC/BPS (all p < 0.01). CONCLUSIONS SNM is an effective therapy for CPP in both IC/BSP and non-IC/BSP patients, with better results in non-IC/BSP patients. Outcomes of the antegrade caudal approach were comparable with the standard retrograde approach.
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Affiliation(s)
- Amr Mahran
- Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Mailstop MAC 5034, Cleveland, OH, 44106, USA.,Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Urology, Assiut University, Assiut, Egypt
| | - Gina Baaklini
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Daisy Hassani
- Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
| | | | | | - Mandy Neudecker
- Core Library, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Adonis K Hijaz
- Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Mailstop MAC 5034, Cleveland, OH, 44106, USA.,Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sangeeta T Mahajan
- Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Mailstop MAC 5034, Cleveland, OH, 44106, USA
| | | | - Sherif A El-Nashar
- Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Mailstop MAC 5034, Cleveland, OH, 44106, USA. .,Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt.
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14
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Goldman HB, Lloyd JC, Noblett KL, Carey MP, Castaño Botero JC, Gajewski JB, Lehur PA, Hassouna MM, Matzel KE, Paquette IM, de Wachter S, Ehlert MJ, Chartier-Kastler E, Siegel SW. International Continence Society best practice statement for use of sacral neuromodulation. Neurourol Urodyn 2018; 37:1823-1848. [PMID: 29641846 DOI: 10.1002/nau.23515] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/04/2018] [Indexed: 12/31/2022]
Abstract
AIMS Sacral neuromodulation (SNM) is an accepted therapy for a variety of conditions. However, despite over 20 years of experience, it remains a specialized procedure with a number of subtleties. Here we present the recommendations issued from the International Continence Society (ICS) SNM Consensus Panel. METHODS Under the auspices of the ICS, eight urologists, three colorectal surgeons and two urogynecologists, covering a wide breadth of geographic and specialty interest representation, met in January 2017 to discuss best practices for neuromodulation. Suggestions for statements were submitted in advance and specific topics were assigned to committee members, who prepared and presented supporting data to the group, at which time each topic was discussed in depth. Best practice statements were formulated based on available data. This document was then circulated to multiple external reviewers after which final edits were made and approved by the group. RESULTS The present recommendations, based on the most relevant data available in the literature, as well as expert opinion, address a variety of specific and at times problematic issues associated with SNM. These include the use of SNM for a variety of underlying conditions, need for pre-procedural testing, use of staged versus single-stage procedures, screening for success during the trial phase, ideal anesthesia, device implantation, post-procedural management, trouble-shooting loss of device function, and future directions for research. CONCLUSIONS These guidelines undoubtedly constitute a reference document, which will help urologists, gynecologists, and colorectal surgeons optimize their use of SNM for refractory urinary urgency and frequency, UUI, NOR, and FI.
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Affiliation(s)
- Howard B Goldman
- Glickman Urology and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jessica C Lloyd
- Glickman Urology and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Karen L Noblett
- Axonics Modulation Technologies and Department of Obstetrics and Gynecology, University of California-Irvine, Irvine, California
| | - Marcus P Carey
- Division of Urogynaecology, Frances Perry House, Parkville, Victoria, Australia
| | | | - Jerzy B Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul A Lehur
- Clinique de Chirurgie Digestive et Endocrinienne, Universite de Nantes, Nantes, France
| | - Magdy M Hassouna
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Klaus E Matzel
- Division of Coloproctology, University of Erlangen, Erlangen, Germany
| | - Ian M Paquette
- Department of Surgery, Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stefan de Wachter
- Department of Urology, University Hospital Antwerpen, University of Antwerpen, Belgium
| | | | - Emmanuel Chartier-Kastler
- Department of Urology, Academic Hospital Pitié-Salpétrière, Medical School Sorbonne Université, Paris, France ECK
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Ogawa T, Ishizuka O, Ueda T, Tyagi P, Chancellor MB, Yoshimura N. Pharmacological management of interstitial cystitis /bladder pain syndrome and the role cyclosporine and other immunomodulating drugs play. Expert Rev Clin Pharmacol 2018; 11:495-505. [PMID: 29575959 DOI: 10.1080/17512433.2018.1457435] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Interstitial cystitis/bladder pain syndrome (IC/BPS) is a symptomatic disorder characterized by pelvic pain and urinary frequency. Immunological responses are considered as one of the possible etiologies of IC/BPS. In this review, we focused on emerging targets, especially on those modulating immunological mechanisms for the treatments of IC/BPS. Area covered: This review was based on the literature search of PubMed/MEDLINE, for which key words following bladder pain syndrome, interstitial cystitis, and/or cyclosporine A (CyA) were used. We discussed current treatments and the drugs targeting the immune responses including CyA and other drugs with different mechanisms including NGF antibodies and P2X3 antagonists. Expert commentary: IC/BPS is often difficult to treat by current treatments. Immunosuppression agents, especially CyA are considered as effective treatments for IC/BPS with Hunner's lesion because these drugs suppress the inflammatory responses in the bladder underlying urinary symptoms of the disease. Base on the previous literatures, we should use CyA for the refractory IC/BPS, especially that with Hunner's lesion due to its side effects. New drugs targeting other mechanisms such as urothelial or afferent nerve dysfunction or new delivery systems such as sustained drug releasing devices or gene therapy techniques may be promising for the future treatments of IC/BPS.
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Affiliation(s)
- Teruyuki Ogawa
- a Department of Urology , Shinshu University School of Medicine , Matsumoto , Japan.,b Department of Urology , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Osamu Ishizuka
- a Department of Urology , Shinshu University School of Medicine , Matsumoto , Japan
| | - Tomohiro Ueda
- c Department of Urology , Ueda Clinic , Kyoto , Japan
| | - Pradeep Tyagi
- b Department of Urology , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Michael B Chancellor
- d Department of Urology , Oakland University William Beaumont School of Medicine , Royal Oak , MI , USA
| | - Naoki Yoshimura
- b Department of Urology , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.,c Department of Urology , Ueda Clinic , Kyoto , Japan
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Tam J, Loeb C, Grajower D, Kim J, Weissbart S. Neuromodulation for Chronic Pelvic Pain. Curr Urol Rep 2018; 19:32. [DOI: 10.1007/s11934-018-0783-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rahnama'i MS, Marcelissen T, Apostolidis A, Veit-Rubin N, Schurch B, Cardozo L, Dmochowski R. The efficacy of botulinum toxin A and sacral neuromodulation in the management of interstitial cystitis (IC)/bladder pain syndrome (BPS), what do we know? ICI-RS 2017 think thank, Bristol. Neurourol Urodyn 2018; 37:S99-S107. [PMID: 29363792 DOI: 10.1002/nau.23493] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/19/2017] [Indexed: 12/21/2022]
Abstract
AIMS This manuscript aims to address the evidence availale in the literature on the efficacy of Botulinum Toxin A (BoNT-A) and sacral neuromodulation (SNM) in patients suffering from Interstitial Cystitis (IC)/BPS and propose further research to identify mechanisms of action and establish the clinical efficacy of either therapy. METHODS At the International Consultation on Incontinence-Research Society (ICI-RS) in 2017, a panel of Functional Urologists and Urogynaecologists participated in a Think Tank (TT) discussing the management of IC/BPS by BoNT-A and SNM, using available data from both PubMed and Medicine literature searches. RESULTS The role of BoNT-A and SNM in the treatment of IC/BPS are discussed and mechanisms of actions are proposed. Despite the available randomized trial data on the effect of intravesical BoNT-A treatment on symptoms of IC/BPS, a consistent conclusion of a positive effect cannot be drawn at the moment, as the published studies are small and heterogeneous in design. There is substantive evidence for the positive effects of SNM on symptoms of IC/BPS patients however, during patient selection, it is important to distinguish the degree and the location of pain in order to tailor the best therapy to the right patients. CONCLUSIONS Both intravesical BoNT-A treatment and SNM have been shown to have positive effects in patients with IC/BPS. However, firm conclusions cannot yet be drawn. Patient-reported outcomes and quality of life should be assessed in addition to urinary and pain symptoms. Since current treatments mainly focus on symptomatic relief, future research should also focus on clarifying the pathogenic mechanisms involved in IC/BPS.
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Affiliation(s)
| | - Tom Marcelissen
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Apostolos Apostolidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Brigitte Schurch
- Department of Clinical Neuroscience, Neuropsychology & Neurorehabilitation Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Linda Cardozo
- Department of Urogynaecology, Kings College Hospital, London, United Kingdom
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University, Nashville, Tennesse
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Tahseen S. Role of sacral neuromodulation in modern urogynaecology practice: a review of recent literature. Int Urogynecol J 2018; 29:1081-1091. [PMID: 29302716 DOI: 10.1007/s00192-017-3546-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/12/2017] [Indexed: 12/01/2022]
Abstract
Sacral neuromodulation (SNM) offers promise in the therapy of many pelvic floor disorders. This innovative treatment has slowly gained popularity. A review of recent literature is presented in relation to its efficacy and complications in various pelvic floor conditions: overactive bladder and urge urinary incontinence, chronic urinary retention, painful bladder syndrome, pelvic pain and double incontinence. It is a minimally invasive, completely reversible safe procedure with good long-term outcomes. However, the treatment is costly, the revision rate is high and patients require life-long follow-up. SNM should always be considered in suitable patients before offering bladder augmentation procedures or urinary diversion or permanent catheterization for bladder dysfunction. SNM should also be considered in patients with double incontinence, after discussion in a urogynaecology/colorectal multidisciplinary team.
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Masterson TA, Masterson JM, Azzinaro J, Manderson L, Swain S, Ramasamy R. Comprehensive pelvic floor physical therapy program for men with idiopathic chronic pelvic pain syndrome: a prospective study. Transl Androl Urol 2017; 6:910-915. [PMID: 29184791 PMCID: PMC5673826 DOI: 10.21037/tau.2017.08.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Male chronic pelvic pain syndrome (CPPS) is a heterogeneous constellation of symptoms that causes significant impairment and is often challenging to treat. In this prospective study, we evaluated men with CPPS who underwent comprehensive pelvic floor physical therapy (PFPT) program. We used the previously validated Genitourinary Pain Index (GUPI) to measure outcomes. Methods We included 14 men who underwent physical therapy for idiopathic CPPS from October 2015 to October 2016. Men with clearly identifiable causes of pelvic pain, such as previous surgery, chronic infection, trauma, prostatitis and epididymitis were excluded. Treatment included: (I) manual therapy (internal and external) of pelvic floor and abdominal musculature to facilitate relaxation of muscles; (II) therapeutic exercises to promote range of motion, improve mobility/flexibility and strengthen weak muscles; (III) biofeedback to facilitate strengthening and relaxation of pelvic floor musculature; (IV) neuromodulation for pelvic floor muscle relaxation and pain relief. GUPI questionnaires were collected at initial evaluation and after the 10th visit. Higher scores reflect worse symptoms. Previous validation of the GUPI calculated a reduction of 7 points to robustly predict being a treatment responder (sensitivity 100%, specificity 76%) and a change in 4 points to predict modest response. Data are presented as medians (ranges). Results A total of 10 patients completed 10 visits, and the remaining four patients completed between 5 and 9 visits. The median National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score at initial evaluation was 30.8 [16–39] and decreased to 22.2 [7–37] at the tenth visit. Five of the 10 patients (50%) in the study had a reduction of greater than 7 points indicating a robust treatment response, and two (20%) had a change of greater than 4 indicating moderate response. Three patients (30%) did not have any meaningful change in NIH-CPSI and the remaining four are in the process of completing 10 sessions. Duration of therapy appears to predict treatment response. Longer duration has better response. Conclusions Male CPPS is difficult to treat and often requires a multimodal approach. Based on the results of our pilot study, pelvic floor rehabilitation may be an effective treatment option for select patients. A larger study with a control group is needed to validate the routine use of pelvic floor rehabilitation in men with CPPS and predict characteristics of men who would respond to therapy.
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Affiliation(s)
| | | | - Jessica Azzinaro
- Department of Physical Therapy, University of Miami, Miami, Florida, USA
| | - Lattoya Manderson
- Department of Physical Therapy, University of Miami, Miami, Florida, USA
| | - Sanjaya Swain
- Department of Urology, University of Miami, Miami, Florida, USA
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Sacral Neuromodulation for Refractory Bladder Pain Syndrome/Interstitial Cystitis: a Global Systematic Review and Meta-analysis. Sci Rep 2017; 7:11031. [PMID: 28887515 PMCID: PMC5591255 DOI: 10.1038/s41598-017-11062-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/17/2017] [Indexed: 11/08/2022] Open
Abstract
Bladder pain syndrome/interstitial cystitis (BPS/IC) is a common debilitating disease and there has not been consistently effective treatment. We aimed to evaluate all available literature regarding the efficacy and safety of sacral neuromodulation (SNM) for refractory BPS/IC. A comprehensive search of Pubmed, Web of Science and Cochrane Library through May 2016 was conducted. A total of 17 studies enrolling 583 patients were identified. Pooled analyses demonstrated that SNM was associated with great reduction in pelvic pain (weighted mean difference [WMD] −3.99; 95% confidence interval [CI] −5.22 to −2.76; p < 0.00001), Interstitial Cystitis Problem and Symptom Index scores (WMD −6.34; 95% CI −9.57 to −3.10; p = 0.0001; and WMD −7.17; 95% CI −9.90 to −4.45; p < 0.00001, respectively), daytime frequency (WMD −7.45; 95% CI −9.68 to −5.22; p < 0.00001), nocturia (WMD −3.01; 95% CI −3.56 to −2.45; p < 0.00001), voids per 24 hours (WMD −9.32; 95% CI −10.90 to −7.74; p < 0.00001) and urgency (WMD −1.08; 95% CI −1.79 to −0.37; p = 0.003) as well as significant improvement in average voided volume (WMD 95.16 ml; 95% CI 63.64 to 126.69; p < 0.0001). The pooled treatment success rate was 84% (95% CI 76% to 91%). SNM-related adverse events were minimal. Current evidence indicates that SNM might be effective and safe for treating refractory BPS/IC.
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Killinger KA, Gupta P, Gilleran JP, Bartley J, Ehlert M, Boura JA, Peters KM. The Impact of Baseline Functional Bladder Capacity on Short-term Neuromodulation Outcomes. Urology 2017; 102:68-72. [DOI: 10.1016/j.urology.2017.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/29/2016] [Accepted: 01/06/2017] [Indexed: 11/30/2022]
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23
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Neuromodulation for Pelvic Pain and Sexual Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Homma Y, Ueda T, Tomoe H, Lin AT, Kuo HC, Lee MH, Oh SJ, Kim JC, Lee KS. Clinical guidelines for interstitial cystitis and hypersensitive bladder updated in 2015. Int J Urol 2016; 23:542-9. [PMID: 27218442 DOI: 10.1111/iju.13118] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/05/2016] [Indexed: 12/24/2022]
Abstract
Clinical guidelines for interstitial cystitis and hypersensitive bladder have been updated as of 2015. The guidelines define interstitial cystitis by the presence of hypersensitive bladder symptoms (discomfort, pressure or pain in the bladder usually associated with urinary frequency and nocturia) and bladder pathology, after excluding other diseases explaining symptoms. Interstitial cystitis is further classified by bladder pathology; either Hunner type interstitial cystitis with Hunner lesions or non-Hunner type interstitial cystitis with mucosal bleeding after distension in the absence of Hunner lesions. Hypersensitive bladder refers to a condition, where hypersensitive bladder symptoms are present, but bladder pathology or other explainable diseases are unproven. Interstitial cystitis and hypersensitive bladder severely affect patients' quality of life as a result of disabling symptoms and/or comorbidities. Reported prevalence suggestive of these disorders varies greatly from 0.01% to >6%. Pathophysiology would be an interaction of multiple factors including urothelial dysfunction, inflammation, neural hyperactivity, exogenous substances and extrabladder disorders. Definite diagnosis of interstitial cystitis and hypersensitive bladder requires cystoscopy with or without hydrodistension. Most of the therapeutic options lack a high level of evidence, leaving a few as recommended therapeutic options.
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Affiliation(s)
- Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Hikaru Tomoe
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Alex Tl Lin
- Department of Urology, National Yang Ming University and Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ming-Huei Lee
- Department of Urology, Feng-Yuan Hospital, Taichung, Taiwan
| | - Seung-June Oh
- Department of Urology, Seoul National University, Seoul, Korea
| | - Joon Chul Kim
- Department of Urology, The Catholic University of Korea, Seoul, Korea
| | - Kyu-Sung Lee
- Department of Urology, Sung Kyun Kwan University School of Medicine, Seoul, Korea
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Cox A, Golda N, Nadeau G, Curtis Nickel J, Carr L, Corcos J, Teichman J. CUA guideline: Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Can Urol Assoc J 2016; 10:E136-E155. [PMID: 27790294 PMCID: PMC5065402 DOI: 10.5489/cuaj.3786] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Nicole Golda
- Department of Urology, North York General Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | | | - Lesley Carr
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Joel Teichman
- University of British Columbia, Vancouver, BC, Canada
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Neuromodulation for the Treatment of Endometriosis-Related Symptoms. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2016. [DOI: 10.5301/je.5000243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sacral and pudendal neuromodulation have been advocated for the treatment of refractory pelvic pain, urinary urgency and retention, as well as fecal incontinence or constipation, all of which are commonly related to endometriosis and/or its surgical treatment. In this review, the mechanisms of action and different routes of neuromodulation will be detailed, as well as all the studied applications of neuromodulation on ameliorating symptoms related to endometriosis and/or its treatment.
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Hoag N, Gani J. Sacral Neuromodulation in Non-Obstructive Urinary Retention and Painful Bladder Syndrome: an Update. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0317-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Dinis S, de Oliveira JT, Pinto R, Cruz F, Buffington CT, Dinis P. From bladder to systemic syndrome: concept and treatment evolution of interstitial cystitis. Int J Womens Health 2015; 7:735-44. [PMID: 26229509 PMCID: PMC4516339 DOI: 10.2147/ijwh.s60798] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Interstitial cystitis, presently known as bladder pain syndrome, has been recognized for over a century but is still far from being understood. Its etiology is unknown and the syndrome probably harbors different diseases. Autoimmune dysfunction, urothelial leakage, infection, central and peripheral nervous system dysfunction, genetic disease, childhood trauma/abuse, and subsequent stress response system dysregulation might be implicated. Management is slowly evolving from a solo act by the end-organ specialist to a team approach based on new typing and phenotyping of the disease. However, oral and invasive treatments are still largely aimed at the bladder and are based on currently proposed pathophysiologic mechanisms. Future research will better define the disease, permitting individualization of treatment.
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Affiliation(s)
- Sara Dinis
- Faculty of Medicine, University of Porto, Porto, Portugal ; Department of Obstetrics and Gynecology, Hospital de São João, Porto, Portugal
| | - Joana Tavares de Oliveira
- Faculty of Veterinary Medicine, ULHT, Lisbon, Portugal ; Institute of Molecular Pathology and Immunology (IPATIMUP), University of Porto, Porto, Portugal
| | - Rui Pinto
- Faculty of Medicine, University of Porto, Porto, Portugal ; Department of Urology, Hospital de São João, Porto, Portugal
| | - Francisco Cruz
- Faculty of Medicine, University of Porto, Porto, Portugal ; Department of Urology, Hospital de São João, Porto, Portugal
| | - Ca Tony Buffington
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, OH, USA
| | - Paulo Dinis
- Faculty of Medicine, University of Porto, Porto, Portugal ; Department of Urology, Hospital de São João, Porto, Portugal
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Taghva A, Romer J, Barolat G. Intraoperative Electromyography as an Adjunct to Sacral Neuromodulation for Chronic Pelvic Pain. Neuromodulation 2014; 18:62-6; discussion 66. [DOI: 10.1111/ner.12193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/09/2014] [Accepted: 02/28/2014] [Indexed: 11/27/2022]
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Sacral Neuromodulation for Refractory Overactive Bladder, Interstitial Cystitis, and Painful Bladder Syndrome. Neurosurg Clin N Am 2014; 25:33-46. [DOI: 10.1016/j.nec.2013.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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32
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The Role of Sacral Nerve Stimulation in Female Pelvic Floor Disorders. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-013-0052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chrysanthopoulou EL, Doumouchtsis SK. Challenges and current evidence on the management of bladder pain syndrome. Neurourol Urodyn 2013; 33:1193-201. [DOI: 10.1002/nau.22475] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 07/09/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Eleftheria L. Chrysanthopoulou
- Department of Obstetrics and Gynaecology; St George's Healthcare NHS Trust/St George's University of London; London United Kingdom
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Yang CC. Neuromodulation in male chronic pelvic pain syndrome: rationale and practice. World J Urol 2013; 31:767-72. [PMID: 23619478 DOI: 10.1007/s00345-013-1066-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 03/21/2013] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION This review explores the treatment of male chronic pelvic pain syndrome (CPPS) (i.e., chronic prostatitis) through the use of neuromodulation, which is the electrical stimulation of the nervous system. Neuromodulation has been used for the treatment of chronic pain for decades, and this review will examine the theory and use of neuromodulation and the various techniques available for the treatment of CPPS. METHODS Existing literature on the use of neuromodulation of the pelvic nerves for the treatment of chronic urogenital pelvic pain was reviewed. Because of limited published research, much of the data are not explicitly for male CPPS. RESULTS Neuromodulation techniques used for chronic pelvic pain conditions include SNS, PTNS and pudendal nerve stimulation. Only SNS and PTNS are currently approved by the US Food and Drug Administration for the treatment of urinary symptoms, and none of these methods are acknowledged as standard therapies for treating chronic pelvic pain syndromes. The improvement of urinary symptoms is more clearly defined than improvements in pain, but at least a subset of patients in most of the published studies and case series derive some benefit in the short term and limited evidence suggests that long-term improvement of symptoms is possible. However, explantation rates are high in all long-term series of patients receiving implantable neuromodulation devices. CONCLUSIONS Neuromodulation appears to provide benefits for patients with CPPS. However, because of the paucity of data and the limitations of small studies, the conclusions of the existing literature must be carefully considered. Because we are still becoming familiar with the pathophysiology of the pain syndromes and the mechanism of neuromodulation on urinary and pain symptoms, we cannot yet predict a particular individual's response to neuromodulation. To determine the long-term efficacy of this therapy, more clinical study is needed to explore the use of neuromodulation in the treatment of male CPPS.
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Affiliation(s)
- Claire C Yang
- Department of Urology, University of Washington, 1959 NE Pacific Street, Box 356510, Seattle, WA 98195-6510, USA.
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Suskind AM, Dunn RL, Kaufman SR, DeLancey JOL, Clemens JQ, Stoffel JT, Hollenbeck BK. Understanding the dissemination of sacral neuromodulation. Surg Innov 2013; 20:625-30. [PMID: 23592732 DOI: 10.1177/1553350613485303] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess trends in the use of sacral neuromodulation and to measure the magnitude of variation in its use across geographic regions. METHODS We used the State Ambulatory Surgery Database (SASD) from 2002 to 2009 from Florida to identify patients implanted with a neuromodulator. Age- and gender-adjusted rates of implantation were calculated by year and by geographic region, defined by the Hospital Service Area. The coefficient of variation was estimated to quantify the magnitude of variation for different time periods. RESULTS Adjusted rates of sacral neuromodulation increased significantly from 1.1 per 100,000 population in 2002 to 10.4 per 100,000 population in 2009. The majority of cases were performed for overactive bladder. There was a very large amount of geographic variation in rates of these procedures as evidenced by the high coefficients of variation: 1.67 (2002 and 2003), 1.70 (2004 and 2005), 1.49 (2006 and 2007), and 1.05 (2008 and 2009). CONCLUSIONS Rates of sacral neuromodulation have increased dramatically over the past decade. However, these rates of utilization are highly variable across regions, with some regions performing large numbers of these procedures and other regions performing few to no procedures. This range in practice patterns may reflect medical uncertainty surrounding the role of this procedure.
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[The care situation of patients with interstitial cystitis in Germany: results of a survey of 270 patients]. Urologe A 2013; 52:691-702. [PMID: 23459923 DOI: 10.1007/s00120-013-3130-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Using a comprehensive questionnaire the care situation of 270 patients with interstitial cystitis (IC) and bladder pain syndrome in Germany was recorded. Despite comprehensive literature on IC (62,000 citations in PubMed) almost nothing is known of the everyday care and quality of patient care in Germany. RESULTS In total 94% of the patients were women and 6% men, the average age of women was 53.5 years and that of men 67 years and 47.77% of the patients felt that they were well or very well informed about the disease whereby the internet was the source of information in many cases. The exchange of information among patients will increase further through social networks. The diagnosis of IC was made most frequently (62.22%) by biopsy and histological examination followed by urodynamics, potassium test, hydrodistension and cystoscopy. The average duration of the diagnosis was 9 years, 46.67% of the patients consulted a doctor more than 20 times before the diagnosis was made and 51.84% had to pass water more than 14 times per day. Frequency, nocturia and pain were the leading symptoms and 25% of the patients complained of urge incontinence. Among oral medications, analgesics were taken most frequently (61.7%) followed by pentosan polysulphate, antidepressants, antiepileptic drugs, antispasmodics and remedies for urinary urgency. In the self-assessment of the success of treatment with oral medications (helped very well and well), pentosan polysulphate, analgesics, antidepressants and antiepileptic drugs were considered to be the best. Medications that restore the glucosamine lining of the bladder were used predominantly for instillation into the bladder included hyaluronic acid, chondroitin sulphate and a combination of both and pentosan polysulphate. In the self-assessment of the success of treatment with instillation therapy (helped very well or well) the order was: chondroitin sulphate (62.69%), hyaluronic acid (55.77%), a combination of both (53.66%) and pentosan polysulphate (46.30%). The electromotive drug administration (EMDA) procedure with the use of direct current to introduce medications into the bladder wall was mentioned surprisingly often, namely, in 119 patients. In the self-assessment success (helped very well or well) was considered the best for intravesical procedures with 61.34%. CONCLUSIONS Compared with all drug procedures instillation of medications into the bladder was mentioned 368 times and was assessed by the patients as having helped very well and noticeably by 53.53%, followed by special invasive procedures at 50.56%/271 mentions, alternative therapies at 41.11%/287 mentions and oral medication at 39.75%/1,024 mentions. Hyaluronic acid and chondroitin sulphate products, the combination of both and pentosan polysulphate (oral and intravesical) are not reimbursed by the statutory health insurance. Over 40% of patients treated with these therefore discontinued the treatment for reasons of cost.
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Srivastava D. Efficacy of sacral neuromodulation in treating chronic pain related to painful bladder syndrome/interstitial cystitis in adults. J Anaesthesiol Clin Pharmacol 2012; 28:428-35. [PMID: 23225919 PMCID: PMC3511936 DOI: 10.4103/0970-9185.101890] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The objective of this review is to evaluate the efficacy and safety of sacral neuromodulation in treating chronic pelvic pain related to Painful bladder syndrome/Interstitial-cystitis. DESIGN The databases searched were MEDLINE and EMBASE [1950- Nov 2011]. Additional searches were performed on the Cochrane Database of Systematic reviews (CDSR), Scopus, CINAHL, BIOSIS, The Cochrane controlled trials register, the science citation index, TRIP DATABASE. RESULTS Overall 70.8% or 170/244 patients were successful at the trial stage. The only randomized controlled trial reported a decrease in Visual analogue pain scores of 49% (7.9 to 4.0) for sacral nerve stimulation [SNS] and 29%(4.5 to 3.2) for pudendal nerve stimulation [PNS] at 6 months follow up. Nine observational studies reported a decrease in pain scores/decrease in pain medications at long term follow up following permanent sacral neuromodulation. One study showed an 80% improvement in Global response assessment score. CONCLUSION The results from the randomised controlled trial and case series/case reports demonstrate a reduction of pain symptoms of Painful bladder syndrome following sacral neuromodulation.
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Affiliation(s)
- Devjit Srivastava
- Consultant Anaesthesia and Pain Medicine, Raigmore Hospitals, Inverness, United Kingdom
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Hope ER, Gruber DD. Coccygeal Fracture Pain Cured by Sacral Neuromodulation: A Case Report. Neuromodulation 2012; 16:614-7. [DOI: 10.1111/ner.12002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 07/08/2012] [Accepted: 09/03/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Erica R. Hope
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery; Walter Reed National Military Medical Center; Bethesda MD USA
| | - Daniel D. Gruber
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery; Walter Reed National Military Medical Center; Bethesda MD USA
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Sacral neuromodulation and intravesical botulinum toxin for refractory overactive bladder. Curr Opin Obstet Gynecol 2012; 24:331-6. [DOI: 10.1097/gco.0b013e3283573ff9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Elliott CS, Payne CK. Interstitial Cystitis and the Overlap With Overactive Bladder. Curr Urol Rep 2012; 13:319-26. [DOI: 10.1007/s11934-012-0264-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sacral Neuromodulation in the Treatment of Interstitial Cystitis/Painful Bladder Syndrome: Should It Be Off Label? CURRENT BLADDER DYSFUNCTION REPORTS 2012. [DOI: 10.1007/s11884-012-0122-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
Chronic pelvic pain syndrome is a poorly understood clinical entity associated with urinary symptoms, pelvic floor dysfunction, and multisystem disorders. Treatment of pelvic floor dysfunction is difficult and often frustrating for the patient as well as for the involved physician. The purpose of this review is to update clinicians on the latest research for the treatment of pelvic floor dysfunction in relation to chronic pelvic pain syndrome.
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Gomelsky A, Dmochowski RR. Update on Neuromodulation. CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0093-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Marcelissen T, Jacobs R, van Kerrebroeck P, de Wachter S. Sacral neuromodulation as a treatment for chronic pelvic pain. J Urol 2011; 186:387-93. [PMID: 21683381 DOI: 10.1016/j.juro.2011.02.2694] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Chronic pelvic pain syndrome is a debilitating disease which often has a major impact on quality of life. A significant number of patients do not respond to conservative treatment and often no good alternative can be offered except radical surgery. Sacral neuromodulation is a well established therapy for patients with lower urinary tract dysfunction. This therapy has also been suggested to be useful in the treatment of chronic pelvic pain. Although currently no Food and Drug Administration approval exists for this indication, several studies have demonstrated promising results. We provide an overview of the published literature on sacral neuromodulation as a treatment for chronic pelvic pain. MATERIALS AND METHODS A PubMed® search was performed to identify articles in English from 1990 to February 2010 reporting treatment of pelvic pain with sacral neuromodulation. In addition, the current definitions of pelvic pain syndromes and the mechanisms of action are discussed. RESULTS A total of 12 relevant articles were identified. Of these articles 10 mainly addressed the efficacy of sacral neuromodulation in patients with interstitial cystitis/bladder pain. The percentage of patients who responded to test stimulation was reported between 51% and 77%. Of the 10 articles 7 reported treatment outcome after implantation. The duration of followup ranged between 5 and 87 months. The mean reduction in pain scores was reported between 40% and 72%. The reoperation rate ranged between 27% and 50% after long-term followup. Two articles included patients with miscellaneous urogenital pain syndromes. The success rates after implantation ranged from 60% to 77% with followup ranging between 19 and 36 months. CONCLUSIONS Currently there is insufficient evidence to determine the role of sacral neuromodulation in the treatment of chronic pelvic pain. Larger prospective trials with long-term evaluation are required to determine the ultimate efficacy of this treatment.
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Affiliation(s)
- T Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
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