Sacral neuromodulation in the management of chronic pelvic pain: A systematic review and meta-analysis.

Greig, Julian; Mak, Quentin; Furrer, Marc A; Sahai, Arun; Raison, Nicholas (2023). Sacral neuromodulation in the management of chronic pelvic pain: A systematic review and meta-analysis. Neurourology and urodynamics, 42(4), pp. 822-836. Wiley-Liss 10.1002/nau.25167

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INTRODUCTION

Sacral neuromodulation (SNM) is a treatment approved for use in several conditions including refractory overactive bladder (OAB) and voiding dysfunction. Chronic pelvic pain (CPP) is a debilitating condition for which treatment is often challenging. SNM shows promising effect in patients with refractory CPP. However, there is a lack of clear evidence, especially in long-term outcomes. This systematic review will assess outcomes of SNM for treating CPP.

METHODS

A systematic search of MEDLINE, Embase, Cochrane Central and clinical trial databases was completed from database inception until January 14, 2022. Studies using original data investigating SNM in an adult population with CPP which recorded pre and posttreatment pain scores were selected. Primary outcome was numerical change in pain score. Secondary outcomes were quality of life assessment and change in medication use and all-time complications of SNM. Risk of bias was assessed using the Newcastle Ottawa Tool for cohort studies.

RESULTS

Twenty-six of 1026 identified articles were selected evaluating 853 patients with CPP. The implantation rate after test-phase success was 64.3%. Significant improvement of pain scores was reported in 13 studies; three studies reported no significant change. WMD in pain scores on a 10-point scale was -4.64 (95% confidence interval [CI] = -5.32 to -3.95, p < 0.00001) across 20 studies which were quantitatively synthesized: effects were maintained at long-term follow-up. Mean follow-up was 42.5 months (0-59). Quality of life was measured by RAND SF-36 and EQ-5D questionnaires and all studies reported improvement in quality of life. One hundred and eighty-nine complications were reported in 1555 patients (Clavien-Dindo Grade I-IIIb). Risk of bias ranged from low to high risk. Studies were case series and bias stemmed from selection bias and loss to follow-up.

CONCLUSION

Sacral Neuromodulation is a reasonably effective treatment of Chronic Pelvic Pain and significantly reduces pain and increases patients' quality of life with immediate to long-term effects.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology

UniBE Contributor:

Furrer, Marc

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0733-2467

Publisher:

Wiley-Liss

Language:

English

Submitter:

Pubmed Import

Date Deposited:

07 Mar 2023 11:13

Last Modified:

13 Apr 2023 00:15

Publisher DOI:

10.1002/nau.25167

PubMed ID:

36877182

Uncontrolled Keywords:

interstitial cystitis nerve stimulation neuromodulation pelvic pain sacral nerve

BORIS DOI:

10.48350/179588

URI:

https://boris.unibe.ch/id/eprint/179588

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