Department of Urology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
Neurourol Urodyn. 2010 Sep;29(7):1267-71. doi: 10.1002/nau.20823.
Chronic pudendal nerve stimulation (CPNS) is a logical alternative particularly in those who fail sacral stimulation. We evaluated symptoms, complications, and satisfaction after CPNS.
We retrospectively reviewed patients having a tined lead placed at the pudendal nerve via the ischial-rectal approach. Demographics, history, complications, and pre-implant voiding diary data were collected. In those responding to CPNS, post-implant symptom changes were measured with the Interstitial Cystitis Symptom and Problem indices (ICSI-PI) and voiding diaries at 3, 6, and 12 months, and a mailed survey.
The majority of 84 patients (78.6% female; age 51.8 ± 16.9 years) had interstitial cystitis/painful bladder syndrome, or overactive bladder. Pudendal response (≥ 50% improvement) occurred in 60/84 (71.4%), however 5 of these chose sacral neuromodulation. Almost all (93.2%) who had previously failed sacral neuromodulation responded to pudendal stimulation. Outcomes were evaluated in 55 continuing on CPNS (median follow up 24.1 months). Seven complications requiring 5 revisions, and 4 other re-operations occurred. Five were explanted. Over time, significant improvements in frequency (P < 0.0001), voided volume (P < 0.0001), incontinence (P < 0.0001), and urgency (P = 0.0019) occurred. ICSI-PI scores significantly improved over 12 months (P < 0.0001). Survey responses indicated that most still had a device (35/40; 87.5%) continuously in use (24/29; 82.8%), and overall bladder, pelvic pain, incontinence, urgency, and frequency symptoms had improved.
CPNS is a reasonable alternative in complex patients refractory to other therapies including sacral neuromodulation. Continued research is needed to fully assess long-term outcomes and identify predictors of success.
慢性阴部神经刺激（CPNS）是一种合理的选择，特别是在那些骶神经刺激失败的患者中。我们评估了 CPNS 后的症状、并发症和满意度。
我们回顾性分析了通过坐骨直肠途径放置阴部神经带刺导线的患者。收集了人口统计学、病史、并发症和植入前排尿日记数据。在对 CPNS 有反应的患者中，使用间质性膀胱炎症状和问题指数（ICSI-PI）和排尿日记在 3、6 和 12 个月时测量植入后的症状变化，并进行邮寄调查。
84 例患者（78.6%为女性；年龄 51.8±16.9 岁）中大多数患有间质性膀胱炎/膀胱疼痛综合征或膀胱过度活动症。60/84（71.4%）例患者出现阴部反应（≥50%改善），但其中 5 例选择了骶神经调节。几乎所有（93.2%）先前骶神经调节失败的患者对阴部刺激有反应。55 例继续接受 CPNS 治疗的患者（中位随访 24.1 个月）进行了结局评估。7 例需要 5 次修订的并发症和 4 例其他再手术发生。5 例被取出。随着时间的推移，频率（P<0.0001）、排空量（P<0.0001）、失禁（P<0.0001）和紧迫性（P=0.0019）显著改善。ICSI-PI 评分在 12 个月时显著改善（P<0.0001）。调查结果表明，大多数患者（35/40；87.5%）仍在持续使用设备（24/29；82.8%），膀胱、骨盆疼痛、失禁、紧迫性和频率症状总体上有所改善。
CPNS 是一种合理的选择，适用于对其他治疗方法（包括骶神经调节）有反应的复杂患者。需要进一步研究以充分评估长期结局并确定成功的预测因素。
