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Long-Term Outcomes of Sacral Neuromodulation for Refractory Interstitial Cystitis/Bladder Pain Syndrome: A
Martina Rekatsina1, Matteo Luigi Giuseppe Leoni2, Veerle Visser-Vandewalle3
1Aretaieion University Hospital, National and Kapodistrian University of Athens, 115 27 Athens, Greece.
Abstract:
Background: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition characterized by persistent bladder-related pain and urinary symptoms, often refractory to conventional treatments. Sacral neuromodulation (SNM) has emerged as a promising therapeutic option for managing refractory IC/BPS. Methods: This retrospective study included 24 patients with IC/BPS treated with SNM between 2017 and 2022. Baseline and follow-up data were collected on pain, opioid use, urinary symptoms, and quality of life. Patients underwent a trial of tonic stimulation before permanent implantation. Continuous variables were reported as median (IQR) and categorical data as counts and percentages. Pre- and post-SNM differences were analyzed using the Wilcoxon rank-sum test. Kaplan-Meier analysis evaluated lead survival, and a Sankey diagram illustrated employment status transitions. Results: Patients had a median age of 54.5 years (IQR: 47-61), with 92% female. Subtypes included Type 1 IC/BPS (8.3%), Type 2 (45.8%), Type 3 (37.6%), and unknown type (8.3%). Median pain duration was 4.5 years (IQR: 3-7.3). SNM resulted in significant improvements in pain (NRS: baseline 8 [IQR: 8-9], last follow-up 3 [IQR: 2-4], p < 0.0001), opioid use (MME: baseline 20 [IQR: 10-40], last follow-up 0 [IQR: 0-10], p < 0.0001), urinary function (24-h voids: baseline 19 [IQR: 14.5-25.8], last follow-up 8 [IQR: 6-12], p < 0.0001), and quality of life (QOL) (EQ-5D-5L: baseline 0.50 [IQR: 0.36-0.56], last follow-up 0.83 [IQR: 0.76-0.89], p < 0.0001). Employment rates increased from 43.5% to 50%, and unemployment decreased from 8.7% to 4.2%. The median follow-up was 35 months (IQR: 28-53). Conclusions: SNM significantly improved pain, urinary symptoms, quality of life, and employment outcomes in patients with refractory IC/BPS. These findings highlight its efficacy as a minimally invasive and reversible option for managing this challenging condition.
