1511 OUTCOMES OF SACRAL NERVE STIMULATION IN PATIENTS WITH OR WITHOUT INTERSTITIAL CYSTITIS/CHRONIC PELVIC PAIN SYNDROME

Abstract

INTRODUCTION AND OBJECTIVES: Sacral nerve stimulation (SNS) is approved for urinary urgency/frequency, urge urinary incontinence and non-obstructive idiopathic urinary retention. Many of these patients also have conditions such as interstitial cystitis (IC) or chronic pelvic pain syndrome (CPPS). Although IC/CPPS is not a primary indication for SNS, anecdotal reports suggest some patients have symptomatic improvements. This study examined clinical outcomes of SNS using a validated instrument, and compared results in those with and without IC/CPPS. METHODS: Prospective data were collected in patients undergoing SNS by a single surgeon. Subjects completed the American Urological Association (AUA) Symptom Index at each preand postoperative visit. Patients were divided into two groups based on whether or not they also had an established diagnosis of IC/CPPS. Total AUA Symptom Score (AUA-SS), quality of life (AUA-QoL) and filling and voiding subscores (AUA-F; AUA-V) were analyzed. Within group analyses were performed using paired t-tests and repeated measures ANOVA. Between group analyses used two-sample t-tests for means, and one-way and factorial ANOVA. Results were considered significant at p 0.05. RESULTS: Sixty-eight subjects (19 men, 49 women), median age 58 (range 21– 86), underwent SNS for clinically indicated symptoms and met inclusion criteria. Group 1 (n 26) also had IC/CPPS, and Group 2 (n 42) did not. Median followup was 4.4 years. Mean AUA-SS improved from 27.3 to 14.9 in Group 1 and 21.7 to 12.1 in Group 2 (both, p 0.0001). Overall, 20 (29%) patients experienced 15 points improvement in total AUA-SS. Mean preoperative AUA-F subscores were worse in Group 1 (13.6) versus Group 2 (10.7) (p 0.0001). Other preoperative parameters were equivalent between groups. Within-group analyses showed improvements in all postoperative variables (AUA-SS, AUA-QoL, AUA-F, AUA-V) for both groups (p 0.0001). Despite statistically significant improvement within groups, mean postoperative AUA-F subscores remained higher in Group 1 versus Group 2 (p 0.038). CONCLUSIONS: To our knowledge, this is the largest study to prospectively compare voiding outcomes after SNS in patients with or without IC/CPPS with a validated instrument. These data demonstrated both groups experienced significant improvement in almost all voiding parameters measured by AUA-SS and its component subscores. Patients should be counseled regarding realistic goals that can be potentially achieved using SNS for voiding symptoms based on presence or absence of IC/CPPS.