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Sacral Nerve Stimulation and Chronic Bladder Pain: Meta-Analysis
Rodwan Husein1, Moein Tavakkoli2, Sara Ahmadi Abhari3
1University College London Hospitals, London, UK; Cleveland Clinic London, London, UK.
Summary
Sacral nerve stimulation (SNS) significantly reduced pain and urinary symptoms in chronic bladder pain syndrome (CBPS) patients. However, more high-quality trials are needed due to study limitations.
Area of Science:
- Urology
- Pain Management
- Neuromodulation
Background:
- Chronic bladder pain syndrome (CBPS) presents significant challenges due to limited treatment efficacy.
- Sacral nerve stimulation (SNS) is an emerging therapy for refractory lower urinary tract symptoms and pelvic pain.
Purpose of the Study:
- To evaluate the effectiveness of sacral nerve stimulation (SNS) for managing pain, urinary symptoms, and quality of life (QoL) in patients with chronic bladder pain syndrome (CBPS).
Main Methods:
- A systematic review and meta-analysis of 15 studies (N=494) were conducted using EMBASE, PubMed, and Cochrane Library.
- Included studies focused on adult CBPS patients treated with SNS, measuring pain scores, Interstitial Cystitis Symptom Index (ICSI), urinary frequency, nocturia, and QoL.
- Risk of bias was assessed, and pooled effect estimates were calculated using random-effects meta-analysis models.
Main Results:
- SNS demonstrated a statistically significant reduction in pain scores (mean difference: -2.27), ICSI (-2.18), urinary frequency (-1.71 voids/day), and nocturia (-1.49 episodes/night).
- No significant changes were observed in Interstitial Cystitis Problem Index (ICPI) or quality of life (QoL).
- Complication rates varied from 0% to 40.6%, with explantation rates between 0% and 18%.
Conclusions:
- Sacral nerve stimulation (SNS) may provide meaningful pain and urinary symptom relief for chronic bladder pain syndrome (CBPS) patients.
- Methodological heterogeneity and risk of bias in current studies limit definitive conclusions.
- Larger, high-quality randomized controlled trials with standardized outcomes are necessary to validate SNS for CBPS treatment.
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