Presentation Authors: Iryna Crescenze, Giulia Lane*, Priyanka Gupta, Ann Arbor, MI
Introduction: Pudendal neuralgia is characterized by pelvic pain in the pudendal nerve distribution that exacerbated by sitting, improved with pudendal nerve blocks, and may have concomitant bladder and bowel symptoms. There is lack of evidence based treatment options for this condition but recent studies have proposed the utility of pudendal neuromodulation in this population. The aim of this study was to optimize patient selection for pudendal neuromodulation to improve overall outcomes.
Methods: Patients undergoing pudendal neuromodulation for indication of refractory pelvic pain and voiding dysfunction from 8/1/2016 to 8/1/2018 at a single institution were identified through retrospective review of electronic medical records. Clinical, demographic, and outcome data was extracted and analyzed. Patients undergoing pudendal neuromodulation for voiding symptoms only were excluded. Prior to proceeding with pudendal neuromodulation diagnoses of pudendal neuralgia was confirmed by assessing for consistent improvement with pudendal blocks. All patients had at least 2 blocks. All patients underwent staged implantation.
Results: Ten patients with chronic pelvic pain and overactive bladder symptoms had a staged trial of pudendal neuromodulation. All patients were women with an average age of 55.4+/-9.7 years and an average duration of symptoms was 6.6 +/- 5.19 years. Sixty percent suffered from depression, 40% had fibromyalgia, and 100% had bowel dysfunction (constipation and/or fecal incontinence). All patient had tried and failed multiple medications and pelvic floor physical therapy. All patients had a positive response to pudendal blocks with 80% having at least 4 blocks. Of the 10 patients, 9 had a successful stage I trial with >50% improvement in pain symptoms and proceeded to stage II. At first follow up AUA symptom scores improved from 14.1+/-9.44 to 5.7+/-2.0 (p=0.037), and quality of life from 4.0+/-1.5 to 1.6+/-2.1(p=0.026). At an average of 8.1+/- 4.9 months of follow up 7/9 were satisfied with the outcomes. Of the 2 patients dissatisfied one went on to have a cystectomy and one had the device removed.
Conclusions: Consistent positive response to pudendal nerve blocks translates to excellent response rates to pudendal neuromodulation with a 90% conversion rate to permanent implant for indication of pain. This cohort also experienced significant improvement in voiding symptoms with continued efficacy during the follow-up period.