Combined site-specific sacral neuromodulation and pudendal nerve release surgery in a patient with interstitial cystitis and persistent arousal.
A variety of neuromodulation approaches have been described for the management of pelvic neuropathies, including interstitial cystitis, pudendal neuralgia and persistent genital arousal disorder. The benefits of a combined sacral and pudendal nerve neuromodulator has yet to be explored for these patients. In this report, we describe the case of a 35-year-old woman with a complex pelvic neuropathy resulting in urinary, sexual and gastro-intestinal dysfunction. She presented with an established diagnosis of interstitial cystitis; however, she also fulfilled diagnostic criteria for pudendal neuralgia and persistent genital arousal disorder. The patient underwent implantation of a combined sacral and pudendal nerve neuoromodulation device at the time of surgical decompression of the pudendal nerves. An impressive clinical response followed. This case demonstrates a unique clinical presentation and highlights the value of a combined surgical and neuromodulatory approach in the management of patients with complex pelvic neuropathies.
Department of Obstetrics and Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
Georgina Louise
GL
Armstrong
Women's Health and Research Institute Australia, Sydney, New South Wales, Australia.
Thierry Georges
TG
Vancaillie
D000328:Adult; D003131:Combined Modality Therapy; D018856:Cystitis, Interstitial / Q000601:surgery / Q000628:therapy*; D019299:Decompression, Surgical; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D058542:Implantable Neurostimulators; D060545:Pudendal Neuralgia / Q000601:surgery / Q000628:therapy*; D020018:Sexual Dysfunctions, Psychological / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome