Sacral neuromodulation for pelvic pain and pelvic organ dysfunction: A case series.

Abstract

The use of neuromodulation is growing and it is an established therapy for conditions such as bladder dysfunction. It is an increasingly used therapy for the management of chronic perineal pain but little research is currently available looking at its efficacy. We present a series of 52 patients who underwent placement of a neuromodulator, the majority of whom suffered from perineal pain, with most placements via the sacral hiatus. Patients were asked to complete a survey recalling their symptoms prior to implantation and describing their symptoms and experience after. The majority had two leads placed via the sacral hiatus. Fifty-two patients had implantation of a permanent neuromodulator and 44 completed at least part of the survey. Forty-eight had leads placed via the sacral hiatus, 29 of whom had these leads only. Forty patients had perineal pain as an indicator and 32 reported that their pain improved; this difference was statistically significant (95% CI: 2.60-4.27, P<0.001). Bladder, bowel and sexual dysfunction were reported by about half the cohort with smaller numbers of improvement for each. Thirty-five patients reported improved quality of life and 32 said they would have the procedure done again. Ten patients had the device removed. We present the largest published case series looking at the use of sacral neuromodulation as a treatment option for pelvic pain and the overall results of our audit are promising for the ongoing use and further development of this modality as a management option.