title: Efficacy of sacral neuromodulation in treatment of bladder pain syndrome: long-term follow-up.
abstract: OBJECTIVE
  This study was sought to evaluate the efficacy and durability of sacral neuromodulation in the treatment of bladder pain syndrome (BPS) patients.
  
  
  METHODS
  A retrospective chart review was performed of patients who had unilateral sacral nerve stimulator (InterStim®) for refractory BPS between June 2002 and December 2004. Patients were qualified for permanent implantation by showing ≥ 50% improvement in their bladder pain and voiding symptoms 1-week post-percutaneous nerve evaluation (PNE). Voiding diary was completed at pre-implantation, 1 year, and on the last visit. Urinary distress inventory short form was completed pre-implantation and on the last visit. Bladder pain was evaluated by visual analogue scale. Primary outcome was improvement in bladder pain. Differences among groups were compared by one-way ANOVA and t-test. Statistical significance was set at P ≤ 0.05.
  
  
  RESULTS
  Twenty-one female patients diagnosed with BPS had PNE; 11 patients (52%) showed ≥ 50% improvement in their bladder pain and voiding symptoms and they consider candidates for permanent implantation (Table I), while 10 patients (48%) failed to show 50% improvement in their voiding symptoms or bladder pain (Table II). In those 11 patients who underwent permanent implantation, the average patient's age was 44.3 ± 8.9 years; average time since diagnosis was 3 ± 0.8 years; the average follow- up was 71.5 ± 9.3 months (Table III). There was significant improvement in the bladder pain and voiding parameters at 1-year follow-up, which was maintained at 5-year follow-up. There was continuous improvement in urgency (1.2 ± 0.68) at 1-year follow-up, and (0.98 ± 0.72) at the last visit. Average voided volume was also continuously improved from 242 ± 62.7 ml at 1-year follow-up to 276 ± 64.7 ml on the last visit.
  
  
  CONCLUSIONS
  Sacral neuromodulation as part of multimodal treatment provides an effective long-term treatment option for sub-group of refractory BPS.
authors.affiliation: Surgery/Urology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada. yahia_ghaz@hotmail.com
authors.forename: Yahya Q
authors.initials: YQ
authors.lastname: Ghazwani
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Elkelini
authors.forename: Magdy M
authors.initials: MM
authors.lastname: Hassouna
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D018856:Cystitis, Interstitial / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008875:Middle Aged; D009864:Ontario; D010147:Pain Measurement; D018579:Patient Selection; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation*; D014563:Urodynamics