Sacral neuromodulation effective for refractory bladder pain syndrome/interstitial cystitis
Sacral neuromodulation (SNM) appears to be a safe and effective treatment method for refractory bladder pain syndrome/interstitial cystitis, according to a new meta-analysis.
The meta-analysis included 17 studies (n=583; 89 percent female), of which eight were prospective cohort studies, eight were retrospective case series and one was a randomized controlled trial (RCT).
Pooled data from 12 trials that focused on pelvic pain showed that SNM significantly reduced pain, as measured by the visual analogue scale, compared to baseline values (weighted mean difference [WMD], -3.99; 95 percent CI, -5.22 to -2.7; p<0.00001).
Two prospective studies and one RCT reported on scores in the interstitial cystitis problem index (ICPI) and interstitial cystitis symptom index (ICSI). These studies revealed significant ICPI (WMD, -6.34; -9.57 to -3.10; p=0.0001) and ICSI (WMD, -7.17; -9.90 to -4.45; p<0.00001) reductions in those who received SNM.
On the other hand, treatment success rate was investigated in 10 studies (n=258) which showed a pooled success rate of 84 percent (76 to 91 percent).
The meta-analysis also showed that daytime frequency (four studies; WMD, -7.45; -9.68 to -5.22; p<0.00001) and nocturia (two studies; WMD, -3.01; -3.56 to -2.45; p<0.00001) improved significantly following SNM.
Significant improvements in urgency (four studies; WMD, -1.06; -1.79 to -0.37; p=0.003) and average voided volume (six studies; WMD 95.16 mL; 63.64 to 126.69; p<0.0001) were also observed.
Overall complication and explantation rates were reported in 14 (n=345) and 10 (n=258) studies, respectively. These yielded a complication rate of 3 percent and an explantation rate of 8 percent.