Document Detail


Chronic pudendal neuromodulation: expanding available treatment options for refractory urologic symptoms.
MedLine Citation:
PMID:  19787710     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Chronic pudendal nerve stimulation (CPNS) is a logical alternative particularly in those who fail sacral stimulation. We evaluated symptoms, complications, and satisfaction after CPNS.
METHODS: We retrospectively reviewed patients having a tined lead placed at the pudendal nerve via the ischial-rectal approach. Demographics, history, complications, and pre-implant voiding diary data were collected. In those responding to CPNS, post-implant symptom changes were measured with the Interstitial Cystitis Symptom and Problem indices (ICSI-PI) and voiding diaries at 3, 6, and 12 months, and a mailed survey.
RESULTS: The majority of 84 patients (78.6% female; age 51.8 ± 16.9 years) had interstitial cystitis/painful bladder syndrome, or overactive bladder. Pudendal response (≥ 50% improvement) occurred in 60/84 (71.4%), however 5 of these chose sacral neuromodulation. Almost all (93.2%) who had previously failed sacral neuromodulation responded to pudendal stimulation. Outcomes were evaluated in 55 continuing on CPNS (median follow up 24.1 months). Seven complications requiring 5 revisions, and 4 other re-operations occurred. Five were explanted. Over time, significant improvements in frequency (P < 0.0001), voided volume (P < 0.0001), incontinence (P < 0.0001), and urgency (P = 0.0019) occurred. ICSI-PI scores significantly improved over 12 months (P < 0.0001). Survey responses indicated that most still had a device (35/40; 87.5%) continuously in use (24/29; 82.8%), and overall bladder, pelvic pain, incontinence, urgency, and frequency symptoms had improved.
CONCLUSIONS: CPNS is a reasonable alternative in complex patients refractory to other therapies including sacral neuromodulation. Continued research is needed to fully assess long-term outcomes and identify predictors of success.
Authors:
Kenneth M Peters; Kim A Killinger; Brian M Boguslawski; Judith A Boura
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurourology and urodynamics     Volume:  29     ISSN:  1520-6777     ISO Abbreviation:  Neurourol. Urodyn.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-29     Completed Date:  2011-01-27     Revised Date:  2011-09-15    
Medline Journal Info:
Nlm Unique ID:  8303326     Medline TA:  Neurourol Urodyn     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1267-71     Citation Subset:  IM    
Copyright Information:
© 2009 Wiley-Liss, Inc.
Affiliation:
Department of Urology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cystitis, Interstitial / complications,  physiopathology,  therapy*
Electric Stimulation Therapy* / adverse effects
Fecal Incontinence / etiology,  therapy
Female
Humans
Male
Michigan
Middle Aged
Pain Measurement
Patient Satisfaction
Pelvic Pain / etiology,  therapy
Questionnaires
Retrospective Studies
Time Factors
Treatment Outcome
Urinary Bladder / innervation*
Urinary Bladder, Overactive / complications,  physiopathology,  therapy*
Urinary Catheterization
Urinary Incontinence / etiology,  therapy
Urodynamics
Comments/Corrections
Comment In:
Eur Urol. 2011 Sep;60(3):596   [PMID:  21806911 ]

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