Sacral neuromodulation treating chronic pelvic pain: a meta-analysis and systematic review of the literature

Mahran, Amr; Baaklini, Gina T.; Hassani, Daisy; Abolella, Hassan A; Safwat, Ahmed S.; Neudecker, Mandy; Hijaz, Adonis; Mahajan, Sahil; Siegel, Steven; El-Nashar, Sherif A.

doi:10.1007/s00192-019-03898-w

Cited by 40 publications

(43 citation statements)

References 56 publications

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“…Chronic pelvic pain syndrome in males and its predominantly female counterpart interstitial cystitis/bladder pain syndrome are chronic conditions of pelvic pain and voiding dysfunction with a poorly understood etiology [109]. Off-label use of SNM in the treatment of these disorders is established with significant results, and similar to its unknown etiology, the way SNM provides subjective and objective improvements in bladder pain syndrome for example is yet to be clearly defined, with obvious differences in outcomes between IC/BPS and non-IC/BPS CPPS [110].…”

Section: Cpps and Ic/bpsmentioning

confidence: 99%

“…A multitude of studies and researchers are reporting on promising results for SNM in symptomatic management of CPP disorders, demonstrating improvements in pain indices and quality of life measures particularly relating to improvements in sleep, social life and sexual activity [110,111]. With 10% of patients of IC/BPS reaching a severe stage refractory to conservative and other modes of management, SNM has found an emerging role in the therapeutic void for this condition.…”

Section: Cpps and Ic/bpsmentioning

confidence: 99%

“…The ICS based on grade C evidence released a level III recommendation that designates SNM as an option for patients who are deemed non-responsive to conservative treatment measures of IC/BPS and non-IC CPPS [4]. However, large randomized controlled trials are lacking, perhaps in part due to the mixed spectrum of CPP disorders, both pathologically and symptomatically, heterogenous patient population, and unclear etiologies, and poorly understood differences in outcomes between the disorders [109,110,113].…”

Section: Cpps and Ic/bpsmentioning

confidence: 99%

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Neuromodulation in Urology: Current Trends and Future Applications

Yaiesh¹,

Al‐Terki²,

Al-Shaiji³

2020

Neurostimulation and Neuromodulation in Contemporary Therapeutic Practice

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Urological applications of neuromodulation and neurostimulation are among the most evolving fields for these technologies. First approved for management of refractory urge incontinence, different modalities of neuromodulation and stimulation have been tested, applied and verified for a vast spectrum of voiding and pelvic floor dysfunction disorders. The modalities of delivering this treatment have also evolved in the last three decades, with a focus on sacral neuromodulation. The experimental and established "off-label" applications of neuromodulation have also encompassed chronic pelvic pain disorders, including chronic prostatitis and bladder pain syndrome, among others. In this chapter, we discuss all the hypothesized theories suggested on how this technology provides therapeutic potential for a number of chronic and debilitating urological conditions, the modes of delivery be it anterior, sacral, and posterior tibial to name a few, and the evolving and future applications.

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Section: Cpps and Ic/bpsmentioning

confidence: 99%

Section: Cpps and Ic/bpsmentioning

confidence: 99%

Section: Cpps and Ic/bpsmentioning

confidence: 99%

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Neuromodulation in Urology: Current Trends and Future Applications

Yaiesh¹,

Al‐Terki²,

Al-Shaiji³

2020

Neurostimulation and Neuromodulation in Contemporary Therapeutic Practice

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“…Neuromodulation, in the form of peripheral nerve stimulation, has been utilized to treat many chronic pain disorders and has found increasing utilization for the treatment of painful bIadder syndromes 1,2 . An animal model utilizing one form of peripheral nerve stimulation, bilateral electrical pudendal nerve stimulation (bPNS), produces inhibition of nociceptive responses to urinary bladder distension (UBD) in rats made hypersensitive to bladder stimuli 3 .…”

Section: Introductionmentioning

confidence: 99%

Medications used to treat bladder disorders may alter effects of neuromodulation

Ness

McNaught

Clodfelder‐Miller

et al. 2020

Neurourology and Urodynamics

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Aims Neuromodulation (nerve stimulation) can produce analgesia. One form, bilateral pudendal nerve stimulation (bPNS), suppresses responses to urinary bladder distension (UBD) in hypersensitive rats. Drugs can modify this effect (eg, benzodiazepines, but not opioids, suppress bPNS effects). Prior to a clinical trial of bPNS effects on bladder pain, we felt it was prudent to survey the effects of medications commonly used in patients with bladder disorders. Methods Bladder hypersensitivity was produced by neonatal bladder inflammation in rat pups coupled with a second inflammatory insult as an adult. Antimuscarinic (oxybutynin), β3‐adrenoceptor agonist (mirabegron, CL316243), α1‐adrenoceptor antagonist (tamsulosin), antidepressant (amitriptyline), muscle relaxing (baclofen), and sedative (propofol) agents were administered and effects of bPNS on responses to UBD assessed. bPNS consisted of bilateral biphasic electrical stimulation of the mixed motor/sensory component of the pudendal nerves. Visceromotor responses (VMRs; abdominal muscle contractile responses) were used as nociceptive endpoints. Results Many of these drugs directly inhibited the VMRs to UBD, but only mirabegron, at the doses employed, significantly reduced inhibitory effects of bPNS. In the presence of the other drugs, bPNS continued to produce statistically significant inhibition of VMRs to UBD. Conclusions This study suggests that concurrent therapy with drugs used to treat bladder disorders could affect assessment of the effects of bPNS on bladder hypersensitivity. This study gives guidance to clinical trials using bPNS for the treatment of painful bladder syndromes and suggests potential clinical use of some of these medications in the treatment of these same disorders.

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“…This study [1] is a systematic review and meta-analysis on sacral neuromodulation (SNM) for the treatment of chronic pelvic pain (CPP). CPP causes a significantly negative impact on the quality of life for patients.…”

mentioning

confidence: 99%

Commentary on: Sacral neuromodulation treating chronic pelvic pain: a meta-analysis and systematic review of the literature

High

2019

Int Urogynecol J

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Sacral neuromodulation treating chronic pelvic pain: a meta-analysis and systematic review of the literature

Cited by 40 publications

References 56 publications

Neuromodulation in Urology: Current Trends and Future Applications

Neuromodulation in Urology: Current Trends and Future Applications

Medications used to treat bladder disorders may alter effects of neuromodulation

Commentary on: Sacral neuromodulation treating chronic pelvic pain: a meta-analysis and systematic review of the literature

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