Do you really want to deactivate your sacral neuromodulation device during pregnancy? A single center case series

Bladder pain syndrome and pregnancy

Bladder pain syndrome (BPS) is a poorly understood condition. In pregnancy, lower urinary tract symptoms and pain are common, but the possibility of BPS is rarely considered and almost never explored. The consequences of BPS on pregnancy and vice versa are poorly understood, and management options appear to be limited. This article reviews the current evidence to allow us to better counsel, investigate, diagnose and manage patients with suspected or known BPS who fall pregnant or who are considering pregnancy. MEDLINE, EMBASE and PubMed were searched for a combination of mesh terms of keywords: 'cystitis', 'interstitial', 'bladder', 'pain' and 'pregnancy'. Relevant articles were identified, reviewed and further relevant articles identified from the references. CONCLUSION: BPS symptoms are very common in pregnancy, with limited data suggesting significant negative effects on the woman and pregnancy. There are safe options for investigation, diagnosis and management in pregnancy. There is a need to raise awareness of the impact of BPS symptoms in pregnancy and the available options for diagnoses and management, improving patient experience and outcomes. PATIENT SUMMARY: Patients with BPS or symptoms akin to BPS need not be abandoned in pregnancy. There is data to support them in making decisions around investigation and management in pregnancy.

Neurostimulation for Chronic Low Back Pain during Pregnancy: Implications for Child and Mother Safety

Pain therapy for low back pain in pregnancy is a very topical issue. In fact, it is necessary to balance the patient's needs to control pain with the need to manage a pregnancy without negative effects on the fetus. We report a case of a 37-year-old woman with low back pain treated with neurostimulation before pregnancy. She described severe chronic low back pain unresponsive to pharmacologic treatments. We first implanted a subcutaneous stimulator into the patient, and then a definitive stimulator resulting in excellent pain control. The improvement in her quality of life allowed the woman to become pregnant. We decided to stop neurostimulation with the patient during pregnancy. The patient completed her pregnancy without complications and the baby was born healthy. During the pregnancy, the woman took only paracetamol when needed. However, this painful symptomatology, completely anecdotal, is not attributable solely to the previous spine problem but probably also to the changes occurring during pregnancy. At the end of pregnancy, the neurostimulator was reactivated without any discomfort for the patient, who is now pain free. This case report provides a first line of evidence of a possible treatment of low back pain in women intending to become pregnant, with risk-free management for both the patient and the child.

Sacral Neuromodulation in Pregnant Women—A Case Report and Literature Review

Millions of women around the world suffer from an overactive bladder and urinary retention. A significant number of them are of reproductive age. For 25 years, SNM has been an effective therapy for treatment-resistant hyperactive bladder and idiopathic urinary retention. The paper presents a case of a 35-year-old pregnant woman with an overactive bladder resistant to pharmacological treatment, who responded positively to sacral neuromodulation. The patient decided against deactivating the neuromodulator and, after an uneventful course of pregnancy, she gave birth by a caesarean section to a healthy female infant. The use of SNM in pregnant patients remains a constant clinical challenge. The current literature was reviewed, but published studies do not provide a clear answer. Further studies with a long follow-up period are necessary to determine more accurately the effects of SNM therapy on the fetus and the course of pregnancy. Currently, it is recommended to deactivate SNM during pregnancy. However, it seems that an individual approach to the patient with information on the risks and benefits of continuing or discontinuing therapy should be the current procedure.