Pudendal nerve stimulation for treatment of lower urinary tract symptoms: A systematic review of safety, technical feasibility and clinical efficacy

Abstract

Aim:Pudendal nerve stimulation (PNS) is a promising neuromodulation option. While sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS) are established third-line treatments for lower urinary tract dysfunction (LUTS), the pudendal nerve offers potential advantages that merit systematic review. The review aims to evaluate the safety, technical feasibility, and clinical efficacy of PNS for the treatment of urinary incontinence. Methods:The review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance with the PRISMA guidelines. PubMed, Embase, and Cochrane Central were searched for studies on PNS, without time or language restriction. The final search date was 12th June 2024. Results:Of 3,020 records screened, 14 studies were included. Two randomised crossover designs and 12 observational studies included a total of 292 patients, predominantly female (n=198; 68%). Safety data were reported by eight studies with a total of 24 adverse events reported in 199 patients (12.1%). These included infections (n=3; 1.5%), lead displacements (n=5, 2.5%) and unwanted stimulation effects including pain (n=10; 5.0%). All studies reported technical outcomes with varying results depending on approach. Operative duration ranged from 20-130min and conversion from percutaneous nerve evaluation to implant varied from 30%–100%. Seven studies included measures of clinical efficacy for LUTS and showed a reduction of 2.92 (5.57 to 2.65) in mean daily incontinence episodes (95% CI: 1.52 to 4.31), alongside improvements in voiding volumes and frequencies. Four studies reported physiological data, with increases in bladder capacity (factor 1.5-2) and effect on undesired detrusor contractions (UDC). Where directly compared, PNS demonstrated comparable or better outcomes than SNM in symptom reduction. Conclusion:PNS appears to be a safe and technically feasible therapy. Clinical outcome data suggest beneficial effects in several LUTS populations including urinary incontinence.