Bilateral electrical pudendal nerve stimulation as additional therapy for lower urinary tract dysfunction when stage II sacral neuromodulator fails: a case report

Abstract

Background Sacral neuromodulation (SNM) has become an effective therapy for patients with lower urinary tract dysfunction (LUTD) who do not respond to conservative treatment. However, an effective treatment strategy for patients who fail SNM has not yet been identified. An option for LUTD is needed when the clinical response to the SNM diminishes. Case presentation A 51-year-old Chinese man presented to an outpatient clinic complaining of difficulty in urination for > 3 years. The patient also complained of urinary frequency and urgency, accompanied by perineal discomfort. He was diagnosed with LUTD based on his symptoms and previous examinations. The patient underwent sacral neuromodulation with a permanent implantable pulse generator (IPG) (provided free of charge by Chengnuo Medical Technology Co., Ltd.; General Stim, Hangzhou, China) in the left buttock, as he participated in the company’s clinical trial to test the long-term effects of IPG. He reported loss of efficacy of the device 3 months after the implantation. We performed bilateral electrical pudendal nerve stimulation (EPNS) therapy for him. After 2 weeks of treatment, he began to report smooth voiding within 2 h after EPNS, and a moderate improvement in urinary frequency, urgency, and perineal discomfort. After 4 weeks of EPNS, the patient reported > 50% improvement in his urination, evaluated with the short form of the International Consultation on Incontinence Questionnaire for Male Lower Urinary Tract Symptoms. He reported smooth voiding, moderate improvements in urinary frequency and urgency, and the disappearance of the perineal discomfort. He also reported improved sleep and erections. The patient was discharged after 8 weeks of EPNS treatment. Conclusion EPNS could be an option as an additional therapy for patients with LUTD who have failed SNM.

Neuromorphic applications in medicine

“…Finally, exploring the potential application of neuromorphic computing to peripheral nerve recording and stimulation is currently limited in the literature, However, application of neuromorphic designs in this context holds promise for a real time sand seamless interface with nerves leading to lowconsumption and high-efficient systems [156,157]. For example, neuromorphic devices for pudendal nerve stimulation hold promise for advancing interventions aimed at improving urinary bladder control [158,159]. Investigating this intersection could lead to innovative approaches that leverage the principles of neuromorphic computing to enhance the effectiveness and efficiency of these implants.…”

Current role of neuromodulation in bladder pain syndrome/interstitial cystitis

“…Other outpatient treatments such as pudendal electroacupuncture have been explored to treat perineal and urethral pain with good results in selected patients. 49 , 50 …”