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International Urogynecology Journal
Published in: International Urogynecology Journal 7/2019

01-07-2019 | Cystitis | Original Article

Sacral neuromodulation treating chronic pelvic pain: a meta-analysis and systematic review of the literature

Authors: Amr Mahran, Gina Baaklini, Daisy Hassani, Hassan A. Abolella, Ahmed S. Safwat, Mandy Neudecker, Adonis K. Hijaz, Sangeeta T. Mahajan, Steven W. Siegel, Sherif A. El-Nashar

Published in: International Urogynecology Journal | Issue 7/2019

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Abstract

Introduction and hypothesis

Sacral neuromodulation (SNM) is gaining popularity as a treatment option for chronic pelvic pain (CPP). Our hypothesis is that SNM is effective in improving CPP.

Methods

A systematic search was conducted through September 2018. Peer-reviewed studies using pre- and postpain intensity scores were selected. The primary outcome was pain improvement on a 10-point visual analog scale (VAS) (adjusted or de novo) in patients with CPP. Secondary outcomes included comparing SNM approaches and etiologies and evaluating lower urinary tract symptoms (LUTS).

Results

Fourteen of 2175 studies, evaluating 210 patients, were eligible for further analysis. The overall VAS pain score improvement was significant [weighted mean difference (WMD) −4.34, 95% confidence interval (CI) = −5.22, to−3.64, p < 0.0001)]. Regarding SNM approach, both standard and caudal approaches had significant reduction in pain scores: WMD −4.32, CI 95% = −5.32, to −3.31 (p < 0.001) for the standard approach, compared with WMD −4.63, 95% CI = −6.57 to −2.69 (P < 0.001), for the caudal approach (p = 0.75). While significant improvement in pain was observed both in patients with and without interstitial cystitis/bladder pain syndrome (IC/BPS), the observed improvement was lower in patients with (WMD −4.13, CI 95% −5.36 to −2.90 versus without (WMD −5.72, CI 95% = −6.18, to−5.27) IC/BPS (p = 0.02). SNM was effective in treating voiding symptoms (frequency, urgency, nocturia) associated with IC/BPS (all p < 0.01).

Conclusions

SNM is an effective therapy for CPP in both IC/BSP and non-IC/BSP patients, with better results in non-IC/BSP patients. Outcomes of the antegrade caudal approach were comparable with the standard retrograde approach.
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Metadata
Title
Sacral neuromodulation treating chronic pelvic pain: a meta-analysis and systematic review of the literature
Authors
Amr Mahran
Gina Baaklini
Daisy Hassani
Hassan A. Abolella
Ahmed S. Safwat
Mandy Neudecker
Adonis K. Hijaz
Sangeeta T. Mahajan
Steven W. Siegel
Sherif A. El-Nashar
Publication date
01-07-2019
Publisher
Springer International Publishing
Published in
International Urogynecology Journal / Issue 7/2019
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-019-03898-w

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