Abstract
BackgroundSacral neuromodulation (SNM) has become an effective therapy for patients with lower urinary tract dysfunction (LUTD) who do not respond to conservative treatment. However, an effective treatment strategy for patients who fail SNM has not yet been identified. An option for LUTD is needed when the clinical response to the SNM diminishes.Case presentationA 51-year-old Chinese man presented to an outpatient clinic complaining of difficulty in urination for > 3 years. The patient also complained of urinary frequency and urgency, accompanied by perineal discomfort. He was diagnosed with LUTD based on his symptoms and previous examinations. The patient underwent sacral neuromodulation with a permanent implantable pulse generator (IPG) (provided free of charge by Chengnuo Medical Technology Co., Ltd.; General Stim, Hangzhou, China) in the left buttock, as he participated in the company’s clinical trial to test the long-term effects of IPG. He reported loss of efficacy of the device 3 months after the implantation. We performed bilateral electrical pudendal nerve stimulation (EPNS) therapy for him. After 2 weeks of treatment, he began to report smooth voiding within 2 h after EPNS, and a moderate improvement in urinary frequency, urgency, and perineal discomfort. After 4 weeks of EPNS, the patient reported > 50% improvement in his urination, evaluated with the short form of the International Consultation on Incontinence Questionnaire for Male Lower Urinary Tract Symptoms. He reported smooth voiding, moderate improvements in urinary frequency and urgency, and the disappearance of the perineal discomfort. He also reported improved sleep and erections. The patient was discharged after 8 weeks of EPNS treatment.ConclusionEPNS could be an option as an additional therapy for patients with LUTD who have failed SNM.
Highlights
Sacral neuromodulation (SNM) has become an effective therapy for patients with lower urinary tract dysfunction (LUTD) who do not respond to conservative treatment
electrical pudendal nerve stimulation (EPNS) could be an option as an additional therapy for patients with LUTD who have failed SNM
The patient complained of both daytime (12–14 times) and nocturnal (4–5 times) urinary frequencies and an urgency with 50–200 mL urine volume every time depending on the amount of fluid intake accompanied by perineal discomfort since he had an episode of withholding urination approximately 2 years prior
Summary
Sacral neuromodulation (SNM) has become an effective therapy for patients with lower urinary tract dysfunction (LUTD) who do not respond to conservative treatment. Conclusion: EPNS could be an option as an additional therapy for patients with LUTD who have failed SNM. Over the last 20 years, SNM has become an effective therapy used in China for This case report is the first to use electrical pudendal nerve stimulation (EPNS) as an additional therapy for a patient who did not respond to stage II sacral neuromodulation.
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