Neuromodulation for Painful Bladder Syndrome/IC

[Violet M]

Two articles - one on pudendal neuromodulation and one on sacral neuromodulation:

http://www.ncbi.nlm.nih.gov/pubmed/23430074

Int Urogynecol J. 2013 Aug;24(8):1243-56. doi: 10.1007/s00192-013-2057-3. Epub 2013 Feb 22.
Interstitial cystitis/bladder pain syndrome: diagnosis and management.
Offiah I, McMahon SB, O'Reilly BA.
Source
Department of Urogynaecology, Cork University Maternity Hospital, Wilton, Ireland, ifeomaoffiah@physicians.ie.
Abstract
INTRODUCTION AND HYPOTHESIS:
The bladder pain syndrome (BPS) is a spectrum of urological symptoms characterised by bladder pain with typical cystoscopic features. Diagnosis and management of this syndrome may be difficult. There is no evidence-based management approach for the diagnosis or treatment of BPS. The objective of this study was to critically review and summarise the evidence relating to the diagnosis and treatment of the bladder pain syndrome.
METHODS:
A review of published data on the diagnosis and treatment of the BPS was performed. Our search was limited to English-language articles, on the "diagnosis", and "management" or "treatment" of "interstitial cystitis" and the "bladder pain syndrome" in "humans."
RESULTS:
Frequency, urgency and pain on bladder filling are the most common symptoms of BPS. All urodynamic volumes are reduced in patients with BPS. Associated conditions include psychological distress, depression, history of sexual assault, irritable bowel syndrome and fibromyalgia. Cystoscopy remains the test for definitive diagnosis, with visualisation of haemorrhage on cystoreduction. A multidisciplinary treatment approach is essential in the management of this condition. Orally administered amitriptyline is an efficacious medical treatment for BPS. Intravesical hyaluronic acid and local anaesthetic, with/without hydrodistension are among new treatment strategies. Sacral or pudendal neuromodulation is effective, minimally invasive and safe. Surgery is reserved for refractory cases.
CONCLUSIONS:
There remains a paucity of evidence for the diagnosis and treatment of BPS. We encountered significant heterogeneity in the assessment of symptoms, duration of treatment and follow up of patients in our literature review.
PMID: 23430074 [PubMed - in process]

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http://www.ncbi.nlm.nih.gov/pubmed/23225919
J Anaesthesiol Clin Pharmacol. 2012 Oct;28(4):428-35. doi: 10.4103/0970-9185.101890.
Efficacy of sacral neuromodulation in treating chronic pain related to painful bladder syndrome/interstitial cystitis in adults.
Srivastava D.
Source
Consultant Anaesthesia and Pain Medicine, Raigmore Hospitals, Inverness, United Kingdom.
Abstract
OBJECTIVE:
The objective of this review is to evaluate the efficacy and safety of sacral neuromodulation in treating chronic pelvic pain related to Painful bladder syndrome/Interstitial-cystitis.
DESIGN:
The databases searched were MEDLINE and EMBASE [1950- Nov 2011]. Additional searches were performed on the Cochrane Database of Systematic reviews (CDSR), Scopus, CINAHL, BIOSIS, The Cochrane controlled trials register, the science citation index, TRIP DATABASE.
RESULTS:
Overall 70.8% or 170/244 patients were successful at the trial stage. The only randomized controlled trial reported a decrease in Visual analogue pain scores of 49% (7.9 to 4.0) for sacral nerve stimulation [SNS] and 29%(4.5 to 3.2) for pudendal nerve stimulation [PNS] at 6 months follow up. Nine observational studies reported a decrease in pain scores/decrease in pain medications at long term follow up following permanent sacral neuromodulation. One study showed an 80% improvement in Global response assessment score.
CONCLUSION:
The results from the randomised controlled trial and case series/case reports demonstrate a reduction of pain symptoms of Painful bladder syndrome following sacral neuromodulation.
KEYWORDS:
Pain, chronic, interstitial cystitis, neuromodulation, painful bladder syndrome, pelvic pain, sacral
PMID: 23225919 [PubMed] PMCID: PMC3511936