Chronic pudendal neuromodulation: expanding available treatment options for refractory urologic symptoms.
OBJECTIVE
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.
Peters
Kenneth M
KM
Department of Urology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
Killinger
Kim A
KA
Boguslawski
Brian M
BM
Boura
Judith A
JA
D000328:Adult; D000368:Aged; D018856:Cystitis, Interstitial / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000009:adverse effects; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D017699:Pelvic Pain / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation*; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D014546:Urinary Catheterization; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy; D014563:Urodynamics