Chronic pudendal neuromodulation: Expanding available treatment options for refractory urologic symptoms

Abstract

Abstract 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. Neurourol. Urodynam. 29:1267–1271, 2010. © 2009 Wiley‐Liss, Inc.