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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

Abstract

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.

Methods

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).

Results

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).

Conclusions

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.

Keywords

Sacral neuromodulation Chronic pelvic pain Visual analog scale 

Abbreviations

SNM

Sacral neuromodulation

CPP

Chronic pelvic pain

VAS

Visual analog scale

IC

Interstitial cystitis

BPS

Bladder pain syndrome

WMD

Weighted mean difference

PNE

Percutaneous nerve evaluation

Notes

Compliance with ethical standards

Financial disclaimer

None.

Conflicts of interest

None.

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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