| Chronic pudendal neuromodulation: expanding available treatment options for refractory urologic symptoms. | |
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MedLine Citation:
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PMID: 19787710 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Kenneth M Peters; Kim A Killinger; Brian M Boguslawski; Judith A Boura |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Neurourology and urodynamics Volume: 29 ISSN: 1520-6777 ISO Abbreviation: Neurourol. Urodyn. Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-09-29 Completed Date: 2011-01-27 Revised Date: 2011-09-15 |
Medline Journal Info:
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Nlm Unique ID: 8303326 Medline TA: Neurourol Urodyn Country: United States |
Other Details:
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Languages: eng Pagination: 1267-71 Citation Subset: IM |
Copyright Information:
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© 2009 Wiley-Liss, Inc. |
Affiliation:
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Department of Urology, William Beaumont Hospital, Royal Oak, MI 48073, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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Eur Urol. 2011 Sep;60(3):596
[PMID:
21806911
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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