Pudendal nerve stimulation for bowel dysfunction in complete cauda equina syndrome.

Area of Science:

• Neurology
• Gastroenterology
• Regenerative Medicine

Background:

• Complete cauda equina syndrome (CES) often leads to debilitating bowel dysfunction.
• Current treatments for CES-related bowel issues have limited efficacy.
• Pudendal nerve stimulation (PNS) presents a potential therapeutic avenue for sacral plexus modulation.

Purpose of the Study:

• To evaluate the efficacy of pudendal nerve stimulation (PNS) as a novel treatment for bowel dysfunction in patients with complete CES.
• To assess the impact of PNS on both constipation-predominant and incontinence-predominant subgroups within the complete CES population.

Main Methods:

• A 3-week trial of PNS was conducted in 13 patients with complete CES (8 constipation-predominant, 5 incontinence-predominant).
• Patients demonstrating ≥50% symptom improvement during the trial proceeded to permanent neurostimulator implantation.
• Clinical outcomes were assessed using validated scoring systems and symptom-specific metrics.

Main Results:

• 63% of constipation-predominant patients (5/8) achieved ≥50% symptom improvement and received permanent implants, with significant reductions in constipation scores and straining.
• All incontinence-predominant patients (5/5) showed ≥50% reduction in incontinent episodes, with improved St Mark's scores and ability to defer defecation.
• Median follow-up of 12 months revealed sustained efficacy, though lead migration and wound infection necessitated device revision in two patients.

Conclusions:

• Pudendal nerve stimulation (PNS) demonstrates short-term effectiveness for managing bowel dysfunction in select patients with complete CES.
• PNS offers a promising therapeutic option for improving quality of life in CES patients experiencing significant bowel control issues.
• Further research with longer follow-up is warranted to optimize PNS application and address potential complications.