Sacral Nerve Stimulation and Chronic Bladder Pain: Meta-Analysis

Chronic bladder pain syndrome (CBPS) is a debilitating condition with limited treatment efficacy. This meta-analysis evaluates the effectiveness of sacral nerve stimulation (SNS) in the management of pain, urinary symptoms, and quality of life (QoL) in patients with CBPS.

A systematic review was conducted across EMBASE, PubMed, and the Cochrane Library, adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Studies involving adult patients with bladder pain symptoms treated with SNS and reported pain scores were included. Pain scores were the primary outcome measure of interest. Secondary outcome measures included Interstitial Cystitis Problem Index (ICPI)/Interstitial Cystitis Symptom Index (ICSI), urinary frequency, nocturia, and QoL. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies-of Interventions, and pooled effect estimates were calculated using random-effects meta-analysis models.

A total of 15 studies (N = 494) were included in the meta-analysis. SNS was associated with a statistically significant reduction in pain scores (mean difference: -2.27 on a 0-10 scale, 95% CI: -2.94 to -1.60, p < 0.001), ICSI (-2.18, 95% CI: -2.99 to -1.37, p < 0.001), urinary frequency (-1.71 voids/d, 95% CI: -2.29 to -1.12), and nocturia (-1.49 episodes/night, 95% CI: -2.35 to -0.63). Changes in ICPI and QoL were not statistically significant. Complication rates ranged from 0% to 40.6%, and explantation rates from 0% to 18%.

This meta-analysis suggests that SNS may offer clinically meaningful pain and urinary symptom relief in patients with CBPS. However, substantial methodological heterogeneity, moderate-to-high risk of bias, and the absence of randomized control trials limit the strength of conclusions. Larger, high-quality trials with standardized diagnostic criteria and outcome measures are essential to establish SNS as a validated treatment option for CBPS.