Chronic pudendal neuromodulation: expanding available treatment options for refractory urologic symptoms

Neurourol Urodyn. 2010 Sep;29(7):1267-71. doi: 10.1002/nau.20823.


Aims: Chronic pudendal nerve stimulation (CPNS) is a logical alternative particularly in those who fail sacral stimulation. We evaluated symptoms, complications, and satisfaction after CPNS.

Methods: 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.

Results: 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.

Conclusions: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cystitis, Interstitial / complications
  • Cystitis, Interstitial / physiopathology
  • Cystitis, Interstitial / therapy*
  • Electric Stimulation Therapy* / adverse effects
  • Fecal Incontinence / etiology
  • Fecal Incontinence / therapy
  • Female
  • Humans
  • Male
  • Michigan
  • Middle Aged
  • Pain Measurement
  • Patient Satisfaction
  • Pelvic Pain / etiology
  • Pelvic Pain / therapy
  • Retrospective Studies
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome
  • Urinary Bladder / innervation*
  • Urinary Bladder, Overactive / complications
  • Urinary Bladder, Overactive / physiopathology
  • Urinary Bladder, Overactive / therapy*
  • Urinary Catheterization
  • Urinary Incontinence / etiology
  • Urinary Incontinence / therapy
  • Urodynamics