[Neuromodulation of lower urinary tract dysfunction]

Short- and mid-term efficacy of sacral neuromodulation in the treatment of neurogenic overactive bladder in patients with multiple sclerosis

BACKGROUND

Sacral neuromodulation (SNM) is commonly used in the treatment of overactive bladder, but few studies have evaluated its efficacy in patients with multiple sclerosis (MS).

OBJECTIVES

To assess the efficacy of SNM in the treatment of neurogenic overactive bladder (nOAB) in patients with MS.

METHODS

All MS patients that underwent a two-stage SNM to treat nOAB between 2013 and 2023 in four university hospitals were considered eligible. The primary outcome was clinical efficacy, defined as the implantation of an implantable pulse generator (IPG). Secondary outcome included the Patient Global Impression of Improvement (PGI-I), the 3-day bladder diary parameters and the maintenance of efficacy within 5 years.

RESULTS

A total of 38 patients were included. The IPG was implanted in 33 patients (87%). The median daily (9.0 to 7.0; p < 0.001) and nocturnal (2.5 to 1.0; p < 0.01) number of micturition/clean self-intermittent catheterization (CISC), the presence of urinary urgency (97% vs 58%; p < 0.01) and urinary incontinence (84% vs 25%, p < 0.001) significantly decreased at the end of the test phase. Efficacy was maintained at 5 years in 46% of cases.

CONCLUSIONS

In MS patients with nOAB, SNM exhibits clinical efficacy comparable to that observed in the non-neurological population.

Analgesic efficacy of sacral neuromodulation for chronic pelvic cancer pain

Background

Neuromodulation has provided promising results in chronic pain management. Sacral neurostimulation (SNS) is a neuromodulatory technique, where the sacral nerve roots are electrically stimulated.

Objective

Evaluate the efficacy of the trial phase to control severe cancer pain in pelvic organs.

Design

Pilot study.

Methods

Chronic pelvic cancer pain patients were managed with morphine ≥ 60 mg daily, duloxetine 30 mg, and celecoxib 200 mg twice daily. Twenty-two adults were divided randomly into two equal groups: the SNS group (N = 11), received a sacral neurostimulator device and opioid analgesics, and the opioid group (N = 11), received increased opioid analgesics to control pain.

Results

Visual analog scale scores were decreased in the SNS group at 24 h, 4 days, 1, and 2 weeks in SNS compared to the opioid group, medians (IQR) [4 (3-5) vs 6 (5-7), 3 (3-4) vs 5 (5-6), 3 (3-4) vs 5 (5-6), and 3 (3-3) vs 5 (4-6) P < 0.001], daily morphine consumption was reduced in the SNS group compared to the opioid group, median (IQR) [90 (60-90) mg vs 120 (120-150) mg, P < 0.001] and [30 (30-60) mg vs 150 (120-180) mg] during the first and second weeks. The SNS group had a better life quality compared to the opioid group after 2 weeks, median (IQR) was (123 (122.5-124) vs 117 (117-118.5) P < 0.001), respectively.

Conclusion

The SNS trial device showed effectiveness in managing severe chronic pelvic cancer pain.

Neuromodulation for Pelvic and Urogenital Pain

Chronic pain affecting the pelvic and urogenital area is a major clinical problem with heterogeneous etiology, affecting both male and female patients and severely compromising quality of life. In cases where pharmacotherapy is ineffective, neuromodulation is proving to be a potential avenue to enhance analgesic outcomes. However, clinicians who frequently see patients with pelvic pain are not traditionally trained in a range of neuromodulation techniques. The aim of this overview is to describe major types of pelvic and urogenital pain syndromes and the neuromodulation approaches that have been trialed, including peripheral nerve stimulation, dorsal root ganglion stimulation, spinal cord stimulation, and brain stimulation techniques. Our conclusion is that neuromodulation, particularly of the peripheral nerves, may provide benefits for patients with pelvic pain. However, larger prospective randomized studies with carefully selected patient groups are required to establish efficacy and determine which patients are likely to achieve the best outcomes.