Improving clinical outcomes with lower motor voltage (≤3 V) during stage 1 sacral neuromodulation for interstitial cystitis or bladder pain syndrome

Abstract

Aims We desire to evaluate whether utilization of ≤3 V (new experimental approach) vs the traditional four or more volts for lead motor response during stage 1 sacral neuromodulation may impart an improvement in voiding and pain parameters. Methods An observational, retrospective, double cohort review was conducted of 179 female patients who experienced medically recalcitrant interstitial cystitis (IC) or bladder pain syndrome (BPS) between January 2002 and January 2013. Group A included 105 women with a motor response of ≤3 V; group B was comprised of 65 women with a motor response at ≥4 V for medically recalcitrant IC or BPS. Patients completed a 3‐day pre‐ and postoperative voiding diary, visual analog pain (VAP) scale, pain urgency frequency (PUF), and Patient Global Impression of Improvement (PGI‐I) questionnaire. Results The mean (standard deviation) follow‐up in months was 120.1 ± 33.3 in group A and 116.3 ± 29.2 in group B (P < .45). A successful conversion from stage 1 to stage 2 showed statistically significant improvement for group A compared with group B (95.4% vs 73.8% conversion rate; P < .001). The success rate also favored group A, with 87.6% success compared with 66.2% for group B (P < .002). Group A mean postoperative VAP scores improved over group B with 3.3 ± 1.2 compared with 5.0 ± 0.8 (P < .001). Group A mean postoperative PUF scores were 10.2 ± 2.7 and group B 14.7 ± 3.5, (P < .001). Conclusions In the ≤3 V patient cohort, a compelling, significant statistical improvement was noted in most clinical voiding parameters, including the VAP, PGI‐I, and performance questionnaires.

Comparing surgical interventions for interstitial cystitis: A systematic review

“…The opposite was true for pain reduction. Marinkovic 34 found greater reductions in symptoms when administering less than 3 V compared to more than 4 V.…”

“…Four studies showed that sacral neuromodulation can be effective at reducing symptom scores 33‐35,37 . Five studies found that sacral neuromodulation can decrease pain and voiding frequency 34‐38 .…”

“…Three studies did not report whether patients had Hunner lesions 33,35,36 . Marinkovic 34 reported their presence but did not analyze outcomes in HIC and BPS patients separately. All patients in Comiter's study 37 suffered from BPS, whereas all patients in Peters’ study 38 suffered from HIC.…”

Commentary: The Vaginal and Urinary Microbiomes in Premenopausal Women With Interstitial Cystitis/Bladder Pain Syndrome as Compared to Unaffected Controls: A Pilot Cross-Sectional Study

“…ICBPS is a disease of unknown etiology, with symptoms of intermittent or chronic pelvic pain and lower urinary tract symptoms such as frequency and urgency. Several therapeutic options are introduced, but none of them improves completely all the symptoms (Marinkovic, 2019). Thus, understanding the pathophysiology of ICBPS could be a milestone in the search for successful treatment.…”

Understanding bladder pain syndrome/interstitial cystitis

“…Medically recalcitrant cases may be suitable for sacral neuromodulation. Success rates, particularly with optimized protocols to include motor response with low (≤3 V) voltage stimulation, can produce clinical benefit, with a reduction in visual analogue pain scores and validated symptom questionnaire scores in up to 95% of patients [19].…”