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Sacral Neuromodulation in the Management of Bladder Pain Syndrome/Interstitial Cystitis. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00579-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Polushkin AA, Isagulyan ED, Tomskiy AA, Dorokhov EV, Salyukov RV. [The use of surgical neuromodulation to treat chronic pelvic pain]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:49-58. [PMID: 31166317 DOI: 10.17116/neiro20198302149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic pelvic pain (CPP) is a pain syndrome that is very difficult to treat. The effectiveness of CPP treatment remains low despite the use of integrated approaches. That is why it is necessary to search for new treatment approaches and methods. Surgical neuromodulation has recently been used increasingly often to treat CPP. OBJECTIVE To evaluate the effectiveness of different types of neurostimulation in patients with chronic pelvic pain. MATERIAL AND METHODS Thirty-two patients were treated at the N.N. Burdenko National Scientific and Practical Center for Neurosurgery. All the patients were diagnosed with CPP and transferred to the Center because of unsatisfactory results of earlier treatment. The mean duration of pain was 8.6 years (range: 1-31 years). Pain intensity and the neuropathic component of the pain syndrome were assessed using the conventional scales and questionnaires (VAS, LANSS, Pain Detect, and DN4). The levels of anxiety, depression, and catastrophic pain were also assessed. The effect of pain on quality of life was evaluated using the modified Brief Pain Inventory (BPI). All the selected patients underwent trial lead implantation at the first stage. Sacral root stimulation was used in 15 patients (unilateral one in 8 patients and bilateral one in 7 patients); three patients underwent spinal cord stimulation; 14 patients were treated with combined neurostimulation. RESULTS In 27 (84.37%) patients, the trial period was regarded as positive and the systems were implanted for chronic neurostimulation. After one year of stimulation, the mean VAS score for pain intensity was 3.53 (compared to 8.61 before the surgery). Regarding quality of life, the most significant effects of treatment were as follows: the number of pain paroxysms was reduced; physical self-maintenance, social life, sleep, and sexual activity were improved; and daily physical activity was increased. CONCLUSION . Neurostimulation ensures a stable pain relief and improves quality of life in patients with chronic pelvic pain refractory to conservative treatment.
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Affiliation(s)
| | | | - A A Tomskiy
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - E V Dorokhov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - R V Salyukov
- People's Friendship University of Russia, Moscow, Russia
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Roy H, Offiah I, Dua A. Neuromodulation for Pelvic and Urogenital Pain. Brain Sci 2018; 8:brainsci8100180. [PMID: 30274287 PMCID: PMC6209873 DOI: 10.3390/brainsci8100180] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Holly Roy
- Neurosurgery Department, University Hospitals Plymouth, Plymouth PL6 8DH, UK.
| | - Ifeoma Offiah
- Department of Obstetrics and Gynaecology, University Hospitals Plymouth, Plymouth PL6 8DH, UK.
| | - Anu Dua
- Department of Obstetrics and Gynaecology, University Hospitals Plymouth, Plymouth PL6 8DH, UK.
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Ismail S, Chartier-Kastler E, Perrouin-Verbe MA, Rose-Dite-Modestine J, Denys P, Phé V. Long-Term Functional Outcomes of S3 Sacral Neuromodulation for the Treatment of Idiopathic Overactive Bladder. Neuromodulation 2017; 20:825-829. [PMID: 28967986 DOI: 10.1111/ner.12696] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/25/2017] [Accepted: 08/14/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the long-term functional outcomes of sacral neuromodulation (SNM) in the treatment of refractory idiopathic overactive bladder (IOAB) and to determine predictive factors for success. MATERIALS AND METHODS To obtain long-term data, all consecutive patients suffering from IOAB and treated by SNM at a single tertiary care center between December 1996 and December 2004 were included. Data regarding patient demographics, past medical, and surgical history, bladder diary, complications as well as device revision and removal rates were collected. Success was defined as an improvement ≥ 50% of any clinical parameter. RESULTS Overall, 34 patients, with a median age of 57.8 years (IQR 44.8-65.7) were included. Immediately after definitive implantation, 2 (6%) patients were lost to follow-up. After a median follow-up of 9.7 years (IQR 4.7-12.0), SNM was considered successful in 20 (63%) patients. Mean amount of protections used per 24 hours significantly decreased (4.1 preoperatively vs. 1.8 at the last follow-up visit, p = 0.02). Devices were removed in 2 (6%) patients due to pain and lack of efficacy. Twenty-two revision surgeries were performed in 15 (47%) patients. First revision surgery occurred after a mean of 6.2 years (± 3.1). Revision surgeries were mainly performed for end of battery life/device dysfunction (n = 18, 82%). No significant predictor for success was identified. CONCLUSIONS With a median follow-up time of 9.7 years, this retrospective SNM study reports a 63% efficacy rate (≥ 50% improvement) for the treatment of refractory IOAB. Moreover, it is a well-tolerated and minimally invasive therapy.
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Affiliation(s)
- Salima Ismail
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, University Paris Sorbonne, Paris, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, University Paris Sorbonne, Paris, France.,Departments of Rehabilitation and Neurourology, Garches Academic Hospital, Assistance Publique-Hôpitaux de Paris, Versailles Saint Quentin en Yvelines University, Montigny le Bretonneux, France.,Inserm Research Unit 1179, Versailles Saint Quentin en Yvelines University, Montigny le Bretonneux, France
| | - Marie-Aimée Perrouin-Verbe
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, University Paris Sorbonne, Paris, France
| | - Johan Rose-Dite-Modestine
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, University Paris Sorbonne, Paris, France
| | - Pierre Denys
- Departments of Rehabilitation and Neurourology, Garches Academic Hospital, Assistance Publique-Hôpitaux de Paris, Versailles Saint Quentin en Yvelines University, Montigny le Bretonneux, France.,Inserm Research Unit 1179, Versailles Saint Quentin en Yvelines University, Montigny le Bretonneux, France
| | - Véronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, University Paris Sorbonne, Paris, France
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Apostolidis A, Averbeck MA, Sahai A, Rahnama'i MS, Anding R, Robinson D, Gravas S, Dmochowski R. Can we create a valid treatment algorithm for patients with drug resistant overactive bladder (OAB) syndrome or detrusor overactivity (DO)? Results from a think tank (ICI-RS 2015). Neurourol Urodyn 2017; 36:882-893. [DOI: 10.1002/nau.23170] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/29/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Apostolos Apostolidis
- 2nd Department of Urology; Aristotle University of Thessaloniki; Thessaloniki Greece
| | | | - Arun Sahai
- Department of Urology; Guy's and St.Thomas’ Hospitals; London UK
| | | | - Ralf Anding
- Department of Neurourology; University Hospital Bonn; Bonn Germany
| | - Dudley Robinson
- Department of Urogynaecology; King's College Hospital; NHS Foundation Trust; London UK
| | - Stavros Gravas
- Department of Urology; University of Thessaly; Larissa Greece
| | - Roger Dmochowski
- Department of Urology; Vanderbilt University; Nashville Tennesse
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Translational approaches to the treatment of benign urologic conditions in elderly women. Curr Opin Urol 2016; 26:184-92. [PMID: 26814884 DOI: 10.1097/mou.0000000000000261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Stress urinary incontinence, overactive bladder, interstitial cystitis/painful bladder syndrome, and underactive bladder are highly prevalent among elderly women, and have significant impact on quality of life; however, existing treatments are limited and are not always successful for all patients. Researchers are investigating a multitude of new therapies to treat these conditions. This review will summarize the recent literature on investigative therapies for these conditions. RECENT FINDINGS Multiple new treatments are being developed for lower urinary tract dysfunction. Some of these treatments, including balloon therapy and muscle-derived stem cells for stress urinary incontinence, could provide alternatives to existing therapies. Others require further research before being used in patients, such as pudendal nerve stimulation for overactive bladder and intravesical liposomes for drug delivery in interstitial cystitis/painful bladder syndrome. SUMMARY Multiple new therapies are being investigated that could provide clinicians with additional tools to treat lower urinary tract disorders in millions of elderly women.
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Pessoa BL, Escudeiro G, Nascimento OJM. Emerging Treatments for Neuropathic Pain. Curr Pain Headache Rep 2015; 19:56. [DOI: 10.1007/s11916-015-0530-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Nyangoh Timoh K, Canlorbe G, Verollet D, Peyrat L, Ballester M, Amarenco G, Darai E. Contribution of sacral neuromodulation to manage persistent voiding dysfunction after surgery for deep infiltrating endometriosis with colorectal involvement: preliminary results. Eur J Obstet Gynecol Reprod Biol 2015; 190:31-5. [PMID: 25966436 DOI: 10.1016/j.ejogrb.2015.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/04/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Around 5% of women experience persistent voiding dysfunction after surgery for deep infiltrating endometriosis (DIE) with colorectal involvement. The gold standard to manage persistent voiding dysfunction is intermittent self-catherization, but this treatment may reduce quality of life of the patients due to care constraints. The objective of our study was to assess the contribution of sacral neuromodulation (SNM) in the management of persistent voiding dysfunction secondary to surgery for DIE with colorectal resection. STUDY DESIGN Five patients referred for persistent voiding dysfunction after surgery for DIE with colorectal resection were included and fitted with a temporary SNM system to test for feasibility. This consisted of placing an electrode unilaterally next to the S3 sacral nerve root and connecting it to an external pacemaker. The patients wore the electrode and the external neurostimulator for 21 days and kept a voiding diary. The SNM test was considered positive when a 50% decrease in self-catheterization was achieved after removal of the electrode. The system was implanted permanently in patients with a positive SNM test. Urodynamic tests were performed before and after the SNM test. RESULTS Two of the five patients had a positive SNM test and were implanted permanently. At 40 months the first patient had completely stopped self-catheterization and the second patient was performing self-catheterization twice a day with a post voiding residue volume of less than 100ml at 52 months. CONCLUSION SNM could be a curative technique in some patients with persistent voiding dysfunction after surgery for DIE. Further studies are required to better select patients who might benefit from SNM testing and subsequent device implantation.
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Affiliation(s)
- Krystel Nyangoh Timoh
- Department of Obstetrics and Gynaecology, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France
| | - Geoffroy Canlorbe
- Department of Obstetrics and Gynaecology, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; Saint Antoine Research Center, UMRS-938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.
| | - Delphine Verollet
- Department of Neuro-urology and Electrophysiological Explorations, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), GRC01 GREEN Sorbonnes Universités, University Pierre and Marie Curie, Paris 6, France
| | - Laurence Peyrat
- Department of Neuro-urology and Electrophysiological Explorations, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), GRC01 GREEN Sorbonnes Universités, University Pierre and Marie Curie, Paris 6, France; Department of Urology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France
| | - Marcos Ballester
- Department of Obstetrics and Gynaecology, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; Saint Antoine Research Center, UMRS-938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Gérard Amarenco
- Department of Neuro-urology and Electrophysiological Explorations, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), GRC01 GREEN Sorbonnes Universités, University Pierre and Marie Curie, Paris 6, France
| | - Emile Darai
- Department of Obstetrics and Gynaecology, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; Saint Antoine Research Center, UMRS-938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
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