Sacral neuromodulation in patients with interstitial cystitis: a multicenter clinical trial

Female patients with interstitial cystitis (IC) unresponsive to standard oral and intravesical therapy were enrolled at three clinical sites for percutaneous sacral nerve root stimulation (PNS) in a prospective, observational pilot study. Evaluation was in the form of a 3-day voiding diary completed both prior to and following the commencement of sacral nerve root stimulation. Symptoms were also assessed by the O'Leary–Sant Interstitial Cystitis Symptom and Problem Indices (ICSI and ICPI). Baseline and test stimulation values for voiding diary parameters and O'Leary–Sant scores were compared to determine treatment efficacy. A total of 33 patients were enrolled. Statistically significant improvements were seen in frequency, pain, average voided volume and maximum voided volume. Significant improvements were also seen in ICSI and ICPI scores. Subacute PNS appears to be effective in reducing symptom severity and increasing voided volumes in patients with IC previously unresponsive to standard therapy. Abbreviations IC Interstitial cystitis - SNS Sacral nerve root stimulation - PNS Percutaneous sacral nerve root stimulation - ICSI Interstitial Cystitis Symptom Index - ICPI Interstitial Cystitis Problem IndexEditorial Comment: The authors demonstrate that temporary sacral nerve stimulation improves the symptoms of refractory interstitial cystitis. This is a well-designed, multi-institutional prospective study using both objective and validated subjective markers to measure outcomes. This paper, along with other previously published studies on sacral neuromodulation for IC, lends support for additional investigations into sacral neuromodulation for refractory IC. Interstitial cystitis can be a difficult disease to treat and patients who are refractory to standard IC therapies either continue to suffer from their symptoms or have only major, irreversible, surgery as their sole option. Reconstructive surgery for IC often leads to poor clinical outcomes. Well-designed studies with long-term follow-up and careful reporting of outcomes of permanent implantation of a pulse generator are needed in IC. If sacral nerve stimulation is shown to improve the symptoms of IC, this will provide a reversible modality to enhance the quality of life of those suffering from this difficult disease.