Sacral neuromodulation for the treatment of refractory interstitial cystitis: outcomes based on technique

Patients with refractory interstitial cystitis (IC) underwent testing with sacral nerve modulation via either a traditional percutaneous approach or a staged procedure. Implanted patients were followed with scaled questionnaires and voiding diaries. Twenty-six patients who had a permanent InterStim placed had a reduction in 24-h voids of 51%. More than two-thirds of patients reported a moderate or marked improvement in urinary frequency, urgency, pelvic pain, pelvic pressure, incontinence and overall quality of life. The test to implant rate of a traditional percutaneous procedure was 52%, compared to a staged procedure of 94%. Assessing sensory response at the time of implant reduced the reoperation rate from 43% to 0%. Ninety-six per cent stated they would undergo an implant again and recommend the therapy to a friend. We concluded that sacral nerve modulation can treat refractory IC symptoms. The response to therapy and the reoperation rate are dependent on the technique used to test and implant the device.Abbreviations IC Interstitial cystitis - TENS Transcutaneous electrical nerve stimulation Editorial Comment: The authors nicely describe a very difficult subset of patients with interstitial cystitis. The patients in this paper have failed six prior treatment modalities before undergoing sacral neural modulation. In this small series the response to therapy and reoperation rate was dependent on the technique used to test and implant the device. Sacral neuromodulation using the staged technique does show significant benefit in the treatment of refractory interstitial cystitis.