title: Sacral neuromodulation decreases narcotic requirements in refractory interstitial cystitis.
abstract: OBJECTIVE
  To assess the efficacy of long-term sacral neuromodulation (InterStim(R), Medtronic Inc., Minneapolis, MN) in treating chronic pelvic pain associated with interstitial cystitis (IC, a symptom complex of urinary urgency, frequency and pelvic pain, often necessitating narcotics) refractory to standard therapy.
  
  
  METHODS
  Twenty-one patients (17 female, four male, mean age 45.5 years, range 17-68) with refractory IC with chronic pelvic pain were reviewed retrospectively. In these patients a mean of six previous treatments for IC had failed. All patients had had cystoscopy and hydrodistension to confirm their diagnoses. All had a permanent InterStim device implanted by one surgeon (K.M.P.) between 2000 and 2002, after responding to a temporary test. Data were collected from chart reviews and patient questionnaires. Intramuscular morphine dose equivalents (MDEs) were calculated before and after implantation.
  
  
  RESULTS
  All 21 patients responded to the questionnaire; the mean (range) follow-up after implantation was 15.4 (7.4-23.1) months. Eighteen patients used chronic narcotics before the InterStim and 20 reported moderate or marked improvement in pain afterward. The mean MDE decreased from 81.6 to 52.0 mg/day (36%) after implantation (P = 0.015). Four of 18 patients stopped all narcotics after InterStim implantation.
  
  
  CONCLUSIONS
  Sacral neuromodulation decreases narcotic requirements and subjective pelvic pain in patients with refractory IC. Further decreases in MDE are anticipated as dose reductions continue in patients who improved.
authors.affiliation: Department of Urology, William Beaumont Hospital, 3535 West 13 Mile Road, Suite 438, Royal Oak, Michigan, USA. kmpeters@beaumont.edu
authors.forename: K M
authors.initials: KM
authors.lastname: Peters
authors.forename: D
authors.initials: D
authors.lastname: Konstandt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D018856:Cystitis, Interstitial / Q000628:therapy*; D004351:Drug Resistance; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D017699:Pelvic Pain / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D009294:Narcotics