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

  • Amr Mahran
  • Gina Baaklini
  • Daisy Hassani
  • Hassan A. Abolella
  • Ahmed S. Safwat
  • Mandy Neudecker
  • Adonis K. Hijaz
  • Sangeeta T. Mahajan
  • Steven W. Siegel
  • Sherif A. El-NasharEmail author
Original Article


Introduction and hypothesis

Sacral neuromodulation (SNM) is gaining popularity as a treatment option for chronic pelvic pain (CPP). Our hypothesis is that SNM is effective in improving CPP.


A systematic search was conducted through September 2018. Peer-reviewed studies using pre- and postpain intensity scores were selected. The primary outcome was pain improvement on a 10-point visual analog scale (VAS) (adjusted or de novo) in patients with CPP. Secondary outcomes included comparing SNM approaches and etiologies and evaluating lower urinary tract symptoms (LUTS).


Fourteen of 2175 studies, evaluating 210 patients, were eligible for further analysis. The overall VAS pain score improvement was significant [weighted mean difference (WMD) −4.34, 95% confidence interval (CI) = −5.22, to−3.64, p < 0.0001)]. Regarding SNM approach, both standard and caudal approaches had significant reduction in pain scores: WMD −4.32, CI 95% = −5.32, to −3.31 (p < 0.001) for the standard approach, compared with WMD −4.63, 95% CI = −6.57 to −2.69 (P < 0.001), for the caudal approach (p = 0.75). While significant improvement in pain was observed both in patients with and without interstitial cystitis/bladder pain syndrome (IC/BPS), the observed improvement was lower in patients with (WMD −4.13, CI 95% −5.36 to −2.90 versus without (WMD −5.72, CI 95% = −6.18, to−5.27) IC/BPS (p = 0.02). SNM was effective in treating voiding symptoms (frequency, urgency, nocturia) associated with IC/BPS (all p < 0.01).


SNM is an effective therapy for CPP in both IC/BSP and non-IC/BSP patients, with better results in non-IC/BSP patients. Outcomes of the antegrade caudal approach were comparable with the standard retrograde approach.


Sacral neuromodulation Chronic pelvic pain Visual analog scale 



Sacral neuromodulation


Chronic pelvic pain


Visual analog scale


Interstitial cystitis


Bladder pain syndrome


Weighted mean difference


Percutaneous nerve evaluation


Compliance with ethical standards

Financial disclaimer


Conflicts of interest


Supplementary material

192_2019_3898_MOESM1_ESM.docx (22 kb)
ESM 1 (DOCX 21.5 kb)
192_2019_3898_MOESM2_ESM.docx (16 kb)
ESM 2 (DOCX 15.8 kb)


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Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  • Amr Mahran
    • 1
    • 2
    • 3
  • Gina Baaklini
    • 2
  • Daisy Hassani
    • 4
  • Hassan A. Abolella
    • 3
  • Ahmed S. Safwat
    • 3
  • Mandy Neudecker
    • 5
  • Adonis K. Hijaz
    • 1
    • 2
  • Sangeeta T. Mahajan
    • 1
  • Steven W. Siegel
    • 6
  • Sherif A. El-Nashar
    • 1
    • 4
    Email author
  1. 1.Division of Female Pelvic Medicine and Reconstructive SurgeryUniversity Hospitals Cleveland Medical CenterClevelandUSA
  2. 2.Urology InstituteUniversity Hospitals Cleveland Medical Center, Case Western Reserve University School of MedicineClevelandUSA
  3. 3.MetroUrologyMinneapolisUSA
  4. 4.Department of Obstetrics and GynecologyAssiut UniversityAssiutEgypt
  5. 5.Department of UrologyAssiut UniversityAssiutEgypt
  6. 6.Core LibraryUniversity Hospitals Cleveland Medical CenterClevelandUSA

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