A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder

Description of the method and preliminary data

Michele Spinelli, Silvia Malaguti, Gianluca Giardiello, Massimo Lazzeri, Jessica Tarantola, Ubi Van Den Hombergh

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

Aims: Pudendal nerve stimulation has beneficial effects on numerous pelvic floor function impairments such as urinary and/or fecal incontinence, retention, and constipation. In preceding literature the implant technique required a fairly complex and invasive surgery, although recent advances with percutaneous placement of the lead through an introducer have made the procedure much less invasive. We performed staged procedure similar to that of sacral neuromodulation (SNM) to place tined lead near the pudendal nerve, using neurophysiological guidance that allowed accurate pudendal nerve stimulation through either perineal or posterior approach. We have named this approach chronic pudendal nerve stimulation (CPNS). Methods: Fifteen neurogenic patients (eight male, seven female) with symptoms of urge incontinence due to neurogenic overactive bladder underwent CPNS. All patients had complete neurophysiological and urodynamic evaluation at baseline and follow-up and were asked to complete voiding and bowel diary for 7 days. Results: During screening, average number of incontinent episodes per day decreased from 7 ± 3.3 to 2.6 ± 3.3 (P <0.02, paired t-test). Eight patients became continent, two improved by more than 88% (from 9 to 1 daily incontinence episode) and two patients reduced the number of incontinence episodes by 50%. The implantable pulse generator (IPG) was subsequently implanted in those 12 patients. Three patients without improvement did not continue to second stage. In implanted patients with 6 months follow-up, urodynamic evaluation showed an objective improvement in the maximum cystometric capacity which increased from 153.3 ± 49.9 to 331.4 ± 110.7 ml (P <0.01, paired t-test). The maximum pressure decreased from 66 ± 24.3 to 36.8 ± 35.9 cmH2O (P = 0.059, paired t-test). Eight patients reported significant improvement in bowel function. Conclusion: Chronic pundedal nerve stimulation is feasible. Neurophysiological guidance is mandatory to place the lead near the pudendal nerve either using perineal or posterior approach. Further studies must be carried out to identify the best stimulation parameters and to verify the long term results.

Original languageEnglish
Pages (from-to)305-309
Number of pages5
JournalNeurourology and Urodynamics
Volume24
Issue number4
DOIs
Publication statusPublished - 2005

Fingerprint

Pudendal Nerve
Neurogenic Urinary Bladder
Urodynamics
Urge Urinary Incontinence
Overactive Urinary Bladder
Fecal Incontinence
Pelvic Floor
Urinary Incontinence
Constipation
Pressure

ASJC Scopus subject areas

  • Clinical Neurology
  • Nephrology
  • Urology

Cite this

A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder : Description of the method and preliminary data. / Spinelli, Michele; Malaguti, Silvia; Giardiello, Gianluca; Lazzeri, Massimo; Tarantola, Jessica; Van Den Hombergh, Ubi.

In: Neurourology and Urodynamics, Vol. 24, No. 4, 2005, p. 305-309.

Research output: Contribution to journalArticle

Spinelli, Michele ; Malaguti, Silvia ; Giardiello, Gianluca ; Lazzeri, Massimo ; Tarantola, Jessica ; Van Den Hombergh, Ubi. / A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder : Description of the method and preliminary data. In: Neurourology and Urodynamics. 2005 ; Vol. 24, No. 4. pp. 305-309.
@article{588b385a744e4550ae30a40199497b1e,
title = "A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder: Description of the method and preliminary data",
abstract = "Aims: Pudendal nerve stimulation has beneficial effects on numerous pelvic floor function impairments such as urinary and/or fecal incontinence, retention, and constipation. In preceding literature the implant technique required a fairly complex and invasive surgery, although recent advances with percutaneous placement of the lead through an introducer have made the procedure much less invasive. We performed staged procedure similar to that of sacral neuromodulation (SNM) to place tined lead near the pudendal nerve, using neurophysiological guidance that allowed accurate pudendal nerve stimulation through either perineal or posterior approach. We have named this approach chronic pudendal nerve stimulation (CPNS). Methods: Fifteen neurogenic patients (eight male, seven female) with symptoms of urge incontinence due to neurogenic overactive bladder underwent CPNS. All patients had complete neurophysiological and urodynamic evaluation at baseline and follow-up and were asked to complete voiding and bowel diary for 7 days. Results: During screening, average number of incontinent episodes per day decreased from 7 ± 3.3 to 2.6 ± 3.3 (P <0.02, paired t-test). Eight patients became continent, two improved by more than 88{\%} (from 9 to 1 daily incontinence episode) and two patients reduced the number of incontinence episodes by 50{\%}. The implantable pulse generator (IPG) was subsequently implanted in those 12 patients. Three patients without improvement did not continue to second stage. In implanted patients with 6 months follow-up, urodynamic evaluation showed an objective improvement in the maximum cystometric capacity which increased from 153.3 ± 49.9 to 331.4 ± 110.7 ml (P <0.01, paired t-test). The maximum pressure decreased from 66 ± 24.3 to 36.8 ± 35.9 cmH2O (P = 0.059, paired t-test). Eight patients reported significant improvement in bowel function. Conclusion: Chronic pundedal nerve stimulation is feasible. Neurophysiological guidance is mandatory to place the lead near the pudendal nerve either using perineal or posterior approach. Further studies must be carried out to identify the best stimulation parameters and to verify the long term results.",
author = "Michele Spinelli and Silvia Malaguti and Gianluca Giardiello and Massimo Lazzeri and Jessica Tarantola and {Van Den Hombergh}, Ubi",
year = "2005",
doi = "10.1002/nau.20118",
language = "English",
volume = "24",
pages = "305--309",
journal = "Neurourology and Urodynamics",
issn = "0733-2467",
publisher = "Wiley-Liss Inc.",
number = "4",

}

TY - JOUR

T1 - A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder

T2 - Description of the method and preliminary data

AU - Spinelli, Michele

AU - Malaguti, Silvia

AU - Giardiello, Gianluca

AU - Lazzeri, Massimo

AU - Tarantola, Jessica

AU - Van Den Hombergh, Ubi

PY - 2005

Y1 - 2005

N2 - Aims: Pudendal nerve stimulation has beneficial effects on numerous pelvic floor function impairments such as urinary and/or fecal incontinence, retention, and constipation. In preceding literature the implant technique required a fairly complex and invasive surgery, although recent advances with percutaneous placement of the lead through an introducer have made the procedure much less invasive. We performed staged procedure similar to that of sacral neuromodulation (SNM) to place tined lead near the pudendal nerve, using neurophysiological guidance that allowed accurate pudendal nerve stimulation through either perineal or posterior approach. We have named this approach chronic pudendal nerve stimulation (CPNS). Methods: Fifteen neurogenic patients (eight male, seven female) with symptoms of urge incontinence due to neurogenic overactive bladder underwent CPNS. All patients had complete neurophysiological and urodynamic evaluation at baseline and follow-up and were asked to complete voiding and bowel diary for 7 days. Results: During screening, average number of incontinent episodes per day decreased from 7 ± 3.3 to 2.6 ± 3.3 (P <0.02, paired t-test). Eight patients became continent, two improved by more than 88% (from 9 to 1 daily incontinence episode) and two patients reduced the number of incontinence episodes by 50%. The implantable pulse generator (IPG) was subsequently implanted in those 12 patients. Three patients without improvement did not continue to second stage. In implanted patients with 6 months follow-up, urodynamic evaluation showed an objective improvement in the maximum cystometric capacity which increased from 153.3 ± 49.9 to 331.4 ± 110.7 ml (P <0.01, paired t-test). The maximum pressure decreased from 66 ± 24.3 to 36.8 ± 35.9 cmH2O (P = 0.059, paired t-test). Eight patients reported significant improvement in bowel function. Conclusion: Chronic pundedal nerve stimulation is feasible. Neurophysiological guidance is mandatory to place the lead near the pudendal nerve either using perineal or posterior approach. Further studies must be carried out to identify the best stimulation parameters and to verify the long term results.

AB - Aims: Pudendal nerve stimulation has beneficial effects on numerous pelvic floor function impairments such as urinary and/or fecal incontinence, retention, and constipation. In preceding literature the implant technique required a fairly complex and invasive surgery, although recent advances with percutaneous placement of the lead through an introducer have made the procedure much less invasive. We performed staged procedure similar to that of sacral neuromodulation (SNM) to place tined lead near the pudendal nerve, using neurophysiological guidance that allowed accurate pudendal nerve stimulation through either perineal or posterior approach. We have named this approach chronic pudendal nerve stimulation (CPNS). Methods: Fifteen neurogenic patients (eight male, seven female) with symptoms of urge incontinence due to neurogenic overactive bladder underwent CPNS. All patients had complete neurophysiological and urodynamic evaluation at baseline and follow-up and were asked to complete voiding and bowel diary for 7 days. Results: During screening, average number of incontinent episodes per day decreased from 7 ± 3.3 to 2.6 ± 3.3 (P <0.02, paired t-test). Eight patients became continent, two improved by more than 88% (from 9 to 1 daily incontinence episode) and two patients reduced the number of incontinence episodes by 50%. The implantable pulse generator (IPG) was subsequently implanted in those 12 patients. Three patients without improvement did not continue to second stage. In implanted patients with 6 months follow-up, urodynamic evaluation showed an objective improvement in the maximum cystometric capacity which increased from 153.3 ± 49.9 to 331.4 ± 110.7 ml (P <0.01, paired t-test). The maximum pressure decreased from 66 ± 24.3 to 36.8 ± 35.9 cmH2O (P = 0.059, paired t-test). Eight patients reported significant improvement in bowel function. Conclusion: Chronic pundedal nerve stimulation is feasible. Neurophysiological guidance is mandatory to place the lead near the pudendal nerve either using perineal or posterior approach. Further studies must be carried out to identify the best stimulation parameters and to verify the long term results.

UR - http://www.scopus.com/inward/record.url?scp=21944443147&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=21944443147&partnerID=8YFLogxK

U2 - 10.1002/nau.20118

DO - 10.1002/nau.20118

M3 - Article

VL - 24

SP - 305

EP - 309

JO - Neurourology and Urodynamics

JF - Neurourology and Urodynamics

SN - 0733-2467

IS - 4

ER -