SUFU 2019: Pudendal Neuromodulation for Pelvic Pain: Optimizing Patient Selection

Miami, FL ( Pudendal neuralgia consistent pain in the pudendal nerve distribution. Dr. Crescenze discusses neuromodulation in this region. This patient may also have bowel and bladder issues as well. There are not very many studies published in this area. Their group would like to study a select group of patients to see if symptoms improved.

Their group of patients included those who had refractory pelvic pain and voiding dysfunction in a two-year time span at their institution.  Patients who were only treated for voiding dysfunction were excluded. It was a retrospective Study to identify these patients. Diagnosis is made by those who responded to a pudendal nerve block on two occasions. Patients did have a staged implant with stage 2 being a two-week trial period.

She did a review the relevant anatomy and placement of the leads as many of the audience members are not familiar with this procedure.

A total of 10 patients with pelvic pain and voiding dysfunction were included in the staged trial. All were women with a mean age of 55.4. The duration of their symptoms the 6.6 years on average. Comorbidities were addressed with 60% having depression, 40% had fibromyalgia, and 100% had a bowel dysfunction. That previously failed conservative therapies like medications and help for physical therapy. Before moving on to narrow modulation, all the patients had a response two pudendal blocks. Her findings are as follows:  nine out of 10 had a successful first day trial with more than 50% improvement in their pain and symptoms. These patients did proceed to stage 2. At a average eight month follow-up seven out of these nine were satisfied with their outcome.

In conclusion, in this small cohort of patients, there was a positive response to pudendal modulation and those patients with pelvic pain and voiding symptoms.

Presented by: Iryna Crescenze, MD, Urology FPMRS Fellow, University of Michigan 


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