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The short-term efficacy of electrical pudendal nerve stimulation versus intravesical instillation for the urethral pain syndrome: a randomized clinical trial

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Abstract

Purpose

Urethral pain syndrome is a chronic condition characterized by disturbing feeling or server pain sensed at the urethra without specific treatment. This double-center, two-arm controlled trial aimed to explore the efficacy of electrical pudendal nerve stimulation (EPNS) versus intravesical instillation (II) of heparin and alkalinized lidocaine for urethral pain syndrome (UPS).

Methods

Eighty eligible patients took three sessions of EPNS, or 1 session of II per week, for 6 consecutive weeks. The primary end point was the change of pelvic pain and urgency/frequency symptom (PUF) score from baseline to week 6. Secondary outcome measures included changes of visual analogue scale (VAS) score and three sub-score extracted from PUF score.

Results

The enrolled participants were all included in the intention-to-treat analyses, and baseline characteristics between the two groups were well balanced. The post-treatment PUF score decreased by 10.0 (7.00, 16.50) in the EPNS group, and by 7.0 (3.00, 10.00) in the II group. At the closure of treatment, the medians of changes in symptom score, bother score, pain-related score and VAS score were 6.50 (4.25, 10.00), 4.00 (2.00, 6.00), 6.00 (5.00, 8.00),4.50 (2.25, 6.00), respectively, in the EPNS group, and 4.00 (2.00, 7.00), 3.00 (1.00, 3.00), 3.00 (2.00, 6.00), 2.00 (1.00, 4.00), respectively, in the II group. All the between-group differences were statistically significant.

Conclusion

Compared with the II, the EPNS results in superior pain control and better relief of lower urinary tract symptoms, and deserves further attention.

Trial registration

ClinicalTrials.gov (NCT03671993)

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Data availability

SY Wang had full access to all the data in the study and takes responsibility for the integrity of the data. Data are available for bona fide researchers who request it from the authors.

References

  1. Engeler D, Berghmans B, Baranowski AP, Borovicka J et al (2021) EAU guidelines on chronic pelvic pain. European Association of Urology. https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Chronic-Pelvic-Pain-2021.pdf

  2. Martinez-Bianchi V, Halstater BH (2010) Urologic chronic pelvic pain syndrome. Prim Care 37(3):527–VIII. https://doi.org/10.1016/j.pop.2010.05.002

    Article  Google Scholar 

  3. Dreger NM, Degener S, Roth S et al (2015) Das urethralsyndrom: fakt oder Fiktion–ein update [Urethral pain syndrome: fact or fiction–an update]. Urologe A 54(9):1248–1255. https://doi.org/10.1007/s00120-015-3926-9

    Article  CAS  PubMed  Google Scholar 

  4. Parsons CL (2011) The role of a leaky epithelium and potassium in the generation of bladder symptoms in interstitial cystitis/overactive bladder, urethral syndrome, prostatitis and gynaecological chronic pelvic pain. BJU Int 107(3):370–375. https://doi.org/10.1111/j.1464-410X.2010.09843.x

    Article  PubMed  Google Scholar 

  5. Parsons CL, Zupkas P, Parsons JK (2001) Intravesical potassium sensitivity in patients with interstitial cystitis and urethral syndrome. Urology 57(3):428–432. https://doi.org/10.1016/s0090-4295(00)01110-9

    Article  CAS  PubMed  Google Scholar 

  6. Price WE (1990) The urethral syndrome: myth or reality? A commentary. Minn Med 73(9):33–34

    CAS  PubMed  Google Scholar 

  7. Parsons CL (2005) Successful downregulation of bladder sensory nerves with combination of heparin and alkalinized lidocaine in patients with interstitial cystitis. Urology 65(1):45–48. https://doi.org/10.1016/j.urology.2004.08.056

    Article  PubMed  Google Scholar 

  8. Wang S, Zhang S, Zhao L (2014) Long-term efficacy of electrical pudendal nerve stimulation for urgency-frequency syndrome in women. Int Urogynecol J 25(3):397–402. https://doi.org/10.1007/s00192-013-2223-7

    Article  PubMed  Google Scholar 

  9. Moher D, Hopewell S, Schulz KF et al (2012) CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg 10(1):28–55. https://doi.org/10.1016/j.ijsu.2011.10.001

    Article  PubMed  Google Scholar 

  10. MacPherson H, Altman DG, Hammerschlag R et al (2010) Revised standards for reporting interventions in clinical trials of acupuncture (STRICTA): extending the CONSORT statement. J Altern Complement Med 16(10):ST1–ST14. https://doi.org/10.1089/acm.2010.1610

    Article  PubMed  Google Scholar 

  11. Li T, Feng X, Lv J et al (2018) Short-term clinical efficacy of electric pudendal nerve stimulation on neurogenic lower urinary tract disease: a pilot research. Urology 112:69–73. https://doi.org/10.1016/j.urology.2017.10.047

    Article  PubMed  Google Scholar 

  12. Parsons CL, Dell J, Stanford EJ et al (2002) Increased prevalence of interstitial cystitis: previously unrecognized urologic and gynecologic cases identified using a new symptom questionnaire and intravesical potassium sensitivity. Urology 60(4):573–578. https://doi.org/10.1016/s0090-4295(02)01829-0

    Article  PubMed  Google Scholar 

  13. Ng CM, Ma WK, To KC et al (2012) The Chinese version of the pelvic pain and urgency/frequency symptom scale: a useful assessment tool for street-ketamine abusers with lower urinary tract symptoms. Hong Kong Med J 18(2):123–130

    CAS  PubMed  Google Scholar 

  14. Parsons CL (2003) Prostatitis, interstitial cystitis, chronic pelvic pain, and urethral syndrome share a common pathophysiology: lower urinary dysfunctional epithelium and potassium recycling. Urology 62(6):976–982. https://doi.org/10.1016/s0090-4295(03)00774-x

    Article  PubMed  Google Scholar 

  15. Gregory NS, Terkawi AS, Prabhakar NK et al (2020) Peripheral nerve stimulation for pudendal neuralgia: a technical note. Pain Med 21(Suppl 1):S51–S55. https://doi.org/10.1093/pm/pnaa171

    Article  PubMed  Google Scholar 

  16. Onda A, Uchida S, Suzuki H et al (2016) Stimulus frequency-dependent inhibition of micturition contractions of the urinary bladder by electrical stimulation of afferent Aβ, Aδ, and C fibers in cutaneous branches of the pudendal nerve. J Physiol Sci 66(6):491–496. https://doi.org/10.1007/s12576-016-0468-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Moayedi M, Davis KD (2013) Theories of pain: from specificity to gate control. J Neurophysiol 109(1):5–12. https://doi.org/10.1152/jn.00457.2012

    Article  PubMed  Google Scholar 

  18. Fu HW, Yan LJ, Liu YY et al (2018) Summary of the study on the effect of different electroacupuncture parameters on the analgesic effect. Shanghai J Acu-mox 37(11):1331–1335. https://doi.org/10.13460/j.issn.1005-0957.2018.11.1331

    Article  Google Scholar 

  19. Lin JG, Chen WL (2008) Acupuncture analgesia: a review of its mechanisms of actions. Am J Chin Med 36(4):635–645. https://doi.org/10.1142/S0192415X08006107

    Article  CAS  PubMed  Google Scholar 

  20. Kim W, Kim SK, Min BI (2013) Mechanisms of electroacupuncture-induced analgesia on neuropathic pain in animal model. Evid Based Complement Alternat Med 2013:436913. https://doi.org/10.1155/2013/436913

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This study was supported by grant from Shanghai Science and Technology Committee and Pudong New Area Health Commission, Shanghai, China.

Funding

This study was supported by grant 09dZ1974900 from Shanghai Science and Technology Committee; by Grant PDZY-2018-0610, PWRd2018-03 from Pudong New Area Health Commission, Shanghai, China.

Author information

Author notes

  1. Tian Li and XinY. Feng are contributed equally.

Authors and Affiliations

  1. Shanghai Pudong Hospital of Traditional Chinese Medicine, Shanghai, China

    Tian Li

  2. Guangming Hospital of Traditional Chinese Medicine, Shanghai, China

    Xin Y. Feng

  3. The Clinical Research Section, Shanghai Research Institute of Acupuncture and Meridian, 650 South Wanping Road, Shanghai, China

    Xiao M. Feng & Si Y. Wang

  4. Department of Urology, Shanghai Jiaotong University School of Medicine Affiliated Renji Hospital, Shanghai, China

    Jian W. Lv & Ting T. Lv

  5. Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Traditional Chinese and Western Medicine, Shanghai, China

    Si Y. Wang

Authors
  1. Tian Li
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  2. Xin Y. Feng
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  3. Xiao M. Feng
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  4. Jian W. Lv
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  5. Ting T. Lv
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  6. Si Y. Wang
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Contributions

Study concept and design SYW, acquisition of data XYF, analysis and interpretation of data TL, drafting of the manuscript TL, critical revision of the manuscript for important intellectual content SYW, JWL, statistical analysis XYF, obtaining funding SYW, TL administrative, technical, or material support SYW, JWL, TTL, supervision XMF.

Corresponding author

Correspondence to Si Y. Wang.

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Conflict of interest

The authors declared that they had no competing interests related to this work.

Ethical approval

Ethical approval was obtained from the Institutional Review Board of Shanghai Yueyang Hospital of Integrated Traditional Chinese and Western Medicine (20180937).

Consent to participate

All participants had signed the written informed consent and voluntarily participated in the trial.

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All authors read and approved the final manuscript and publication.

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Li, T., Feng, X.Y., Feng, X.M. et al. The short-term efficacy of electrical pudendal nerve stimulation versus intravesical instillation for the urethral pain syndrome: a randomized clinical trial. World J Urol 39, 3993–3998 (2021). https://doi.org/10.1007/s00345-021-03698-2

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  • DOI: https://doi.org/10.1007/s00345-021-03698-2

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