Combined site-specific sacral neuromodulation and pudendal nerve release surgery in a patient with interstitial cystitis and persistent arousal

BMJ Case Rep. 2016 Jun 9:2016:bcr2015213513. doi: 10.1136/bcr-2015-213513.

Abstract

A variety of neuromodulation approaches have been described for the management of pelvic neuropathies, including interstitial cystitis, pudendal neuralgia and persistent genital arousal disorder. The benefits of a combined sacral and pudendal nerve neuromodulator has yet to be explored for these patients. In this report, we describe the case of a 35-year-old woman with a complex pelvic neuropathy resulting in urinary, sexual and gastro-intestinal dysfunction. She presented with an established diagnosis of interstitial cystitis; however, she also fulfilled diagnostic criteria for pudendal neuralgia and persistent genital arousal disorder. The patient underwent implantation of a combined sacral and pudendal nerve neuoromodulation device at the time of surgical decompression of the pudendal nerves. An impressive clinical response followed. This case demonstrates a unique clinical presentation and highlights the value of a combined surgical and neuromodulatory approach in the management of patients with complex pelvic neuropathies.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Combined Modality Therapy
  • Cystitis, Interstitial / surgery
  • Cystitis, Interstitial / therapy*
  • Decompression, Surgical
  • Electric Stimulation Therapy*
  • Female
  • Humans
  • Implantable Neurostimulators*
  • Pudendal Neuralgia / surgery
  • Pudendal Neuralgia / therapy*
  • Sexual Dysfunctions, Psychological / surgery
  • Sexual Dysfunctions, Psychological / therapy*
  • Treatment Outcome