{"paper_id":"8b4ae671-3be7-4efb-9bc1-b465991313f7","body_text":"Abstract\nIntroduction and hypothesis\nSacral neuromodulation (SNM) is gaining popularity as a treatment option for chronic pelvic pain (CPP). Our hypothesis is that SNM is effective in improving CPP.\nMethods\nA systematic search was conducted through September 2018. Peer-reviewed studies using pre- and postpain intensity scores were selected. The primary outcome was pain improvement on a 10-point visual analog scale (VAS) (adjusted or de novo) in patients with CPP. Secondary outcomes included comparing SNM approaches and etiologies and evaluating lower urinary tract symptoms (LUTS).\nResults\nFourteen of 2175 studies, evaluating 210 patients, were eligible for further analysis. The overall VAS pain score improvement was significant [weighted mean difference (WMD) −4.34, 95% confidence interval (CI) = −5.22, to−3.64, p < 0.0001)]. Regarding SNM approach, both standard and caudal approaches had significant reduction in pain scores: WMD −4.32, CI 95% = −5.32, to −3.31 (p < 0.001) for the standard approach, compared with WMD −4.63, 95% CI = −6.57 to −2.69 (P < 0.001), for the caudal approach (p = 0.75). While significant improvement in pain was observed both in patients with and without interstitial cystitis/bladder pain syndrome (IC/BPS), the observed improvement was lower in patients with (WMD −4.13, CI 95% −5.36 to −2.90 versus without (WMD −5.72, CI 95% = −6.18, to−5.27) IC/BPS (p = 0.02). SNM was effective in treating voiding symptoms (frequency, urgency, nocturia) associated with IC/BPS (all p < 0.01).\nConclusions\nSNM is an effective therapy for CPP in both IC/BSP and non-IC/BSP patients, with better results in non-IC/BSP patients. Outcomes of the antegrade caudal approach were comparable with the standard retrograde approach.\nSimilar content being viewed by others\nAbbreviations\n- SNM:\n-\nSacral neuromodulation\n- CPP:\n-\nChronic pelvic pain\n- VAS:\n-\nVisual analog scale\n- IC:\n-\nInterstitial cystitis\n- BPS:\n-\nBladder pain syndrome\n- WMD:\n-\nWeighted mean difference\n- PNE:\n-\nPercutaneous nerve evaluation\nReferences\nMathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996;87(3):321–7.\n(RCOG) RCoOaG. Royal College of Obstetricians and Gynaecologists guidelines: The initial management of chronic pelvic pain. London (UK): Royal College of Obstetricians and Gynaecologists (RCOG). https://www.guideline.gov/summaries/summary/37221/the-initial-management-of-chronic-pelvic-pain?q=pelvic+pain (2012). 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Urology. 2007;69(3):441–3.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nFinancial disclaimer\nNone.\nConflicts of interest\nNone.\nAdditional information\nPublisher’s note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nElectronic supplementary material\nESM 1 (download DOCX )\n(DOCX 21.5 kb)\nESM 2 (download DOCX )\n(DOCX 15.8 kb)\nAppendix\nAppendix\nDatabase(s): Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily 1946 to 14 September 2018.\nSearch Strategy:\nNo. | Searches | Results |\n1 | exp Electric Stimulation Therapy/ | 72,449 |\n2 | (electric adj2 stimulation*).ti,ab. | 5183 |\n3 | (nerve adj2 stimulation*).ti,ab. | 21,658 |\n4 | Neuromodulation*.mp. | 6090 |\n5 | neurostimulat*.mp. | 2998 |\n6 | or/1–5 | 98,181 |\n7 | URINARY INCONTINENCE/or FECAL INCONTINENCE/or URINARY INCONTINENCE, URGE/or URINARY INCONTINENCE, STRESS/ | 37,753 |\n8 | incontinence.ti,ab. | 42,912 |\n9 | incontinent.ti,ab. | 3853 |\n10 | exp Urinary Bladder Diseases/ | 95,824 |\n11 | bladder.ti,ab. | 142,717 |\n12 | cystitis.ti,ab. | 10,417 |\n13 | Urination Disorders/ | 10,985 |\n14 | (urin* adj2 disorder*).ti,ab. | 1609 |\n15 | Pelvic Pain/ | 4796 |\n16 | “pelvic pain”.ti,ab. | 8048 |\n17 | or/7–16 | 230,545 |\n18 | exp SACRUM/ | 8306 |\n19 | sacrum.ti,ab. | 4813 |\n20 | sacral.ti,ab. | 15,321 |\n21 | or/18–20 | 22,162 |\n22 | 6 and 17 and 21 | 1512 |\n23 | limit 22 to animals | 150 |\n24 | 22 not 23 | 1362 |\n25 | limit 24 to (case reports or comment or editorial or letter) | 148 |\n26 | 24 not 25 | 1214 |\n27 | limit 26 to (english language and last 30 years) | 1061 |\n28 | from 27 keep 1–1061 | 1061 |\nPubMed Medline\n(((((((((((Electric Stimulation Therapy[MeSH Terms]) OR electric stimulation*[Title/Abstract]) OR nerve stimulation*[Title/Abstract]) OR Neuromodulation*) OR neurostimulat*[Title/Abstract])) AND ((((((((((((((URINARY INCONTINENCE[MeSH Terms]) OR FECAL INCONTINENCE[MeSH Terms]) OR urinary incontinence, urge[MeSH Terms]) OR urinary incontinence, stress[MeSH Terms])) OR incontinence[Title/Abstract]) OR incontinent[Title/Abstract]) OR Urinary Bladder Diseases[MeSH Terms]) OR bladder[Title/Abstract]) OR cystitis[Title/Abstract]) OR Urination Disorders[MeSH Terms]) OR Urination Disorder*[Title/Abstract]) OR “Pelvic Pain”[Mesh:noexp]) OR pelvic pain[Title/Abstract])) AND (((SACRUM[MeSH Terms]) OR sacrum[Title/Abstract]) OR sacral[Title/Abstract]))) NOT (((((((((Electric Stimulation Therapy[MeSH Terms]) OR electric stimulation*[Title/Abstract]) OR nerve stimulation*[Title/Abstract]) OR Neuromodulation*) OR neurostimulat*[Title/Abstract])) AND ((((((((((((((URINARY INCONTINENCE[MeSH Terms]) OR FECAL INCONTINENCE[MeSH Terms]) OR urinary incontinence, urge[MeSH Terms]) OR urinary incontinence, stress[MeSH Terms])) OR incontinence[Title/Abstract]) OR incontinent[Title/Abstract]) OR Urinary Bladder Diseases[MeSH Terms]) OR bladder[Title/Abstract]) OR cystitis[Title/Abstract]) OR Urination Disorders[MeSH Terms]) OR Urination Disorder*[Title/Abstract]) OR “Pelvic Pain”[Mesh:noexp]) OR pelvic pain[Title/Abstract])) AND (((SACRUM[MeSH Terms]) OR sacrum[Title/Abstract]) OR sacral[Title/Abstract])) AND ((Case Reports[ptyp] OR Comment[sb] OR Editorial[ptyp] OR Letter[ptyp]))))) NOT (((((((((((Electric Stimulation Therapy[MeSH Terms]) OR electric stimulation*[Title/Abstract]) OR nerve stimulation*[Title/Abstract]) OR Neuromodulation*) OR neurostimulat*[Title/Abstract])) AND ((((((((((((((URINARY INCONTINENCE[MeSH Terms]) OR FECAL INCONTINENCE[MeSH Terms]) OR urinary incontinence, urge[MeSH Terms]) OR urinary incontinence, stress[MeSH Terms])) OR incontinence[Title/Abstract]) OR incontinent[Title/Abstract]) OR Urinary Bladder Diseases[MeSH Terms]) OR bladder[Title/Abstract]) OR cystitis[Title/Abstract]) OR Urination Disorders[MeSH Terms]) OR Urination Disorder*[Title/Abstract]) OR “Pelvic Pain”[Mesh:noexp]) OR pelvic pain[Title/Abstract])) AND (((SACRUM[MeSH Terms]) OR sacrum[Title/Abstract]) OR sacral[Title/Abstract]))) NOT (((((((((Electric Stimulation Therapy[MeSH Terms]) OR electric stimulation*[Title/Abstract]) OR nerve stimulation*[Title/Abstract]) OR Neuromodulation*) OR neurostimulat*[Title/Abstract])) AND ((((((((((((((URINARY INCONTINENCE[MeSH Terms]) OR FECAL INCONTINENCE[MeSH Terms]) OR urinary incontinence, urge[MeSH Terms]) OR urinary incontinence, stress[MeSH Terms])) OR incontinence[Title/Abstract]) OR incontinent[Title/Abstract]) OR Urinary Bladder Diseases[MeSH Terms]) OR bladder[Title/Abstract]) OR cystitis[Title/Abstract]) OR Urination Disorders[MeSH Terms]) OR Urination Disorder*[Title/Abstract]) OR “Pelvic Pain”[Mesh:noexp]) OR pelvic pain[Title/Abstract])) AND (((SACRUM[MeSH Terms]) OR sacrum[Title/Abstract]) OR sacral[Title/Abstract])) AND ((Case Reports[ptyp] OR Comment[sb] OR Editorial[ptyp] OR Letter[ptyp])))) AND Animals[Mesh:noexp]) English language- 1988-2018.\nEmbase Session Results (18 Sep 2018)\nNo. | Query | Results |\n30 | 27 NOT 28 AND [english]/lim AND [1988–2018]/py | 1212 |\n29 | 27 NOT 28 | 1413 |\n28 | 25 NOT 26 AND [animals]/lim | 177 |\n27 | 25 NOT 26 | 1590 |\n26 | 25 AND ‘case report’/de | 123 |\n25 | 23 NOT 24 | 1713 |\n24 | 23 AND (‘conference abstract’/it OR ‘conference paper’/it OR ‘conference review’/it OR ‘editorial’/it OR ‘letter’/it) | 1261 |\n23 | 7 AND 11 AND 22 | 2974 |\n22 | 12 OR 13 OR 14 OR 15 OR 16 OR 17 OR 18 OR 19 OR 20 OR 21 | 411,367 |\n21 | pelvis NEAR/2 pain | 13,619 |\n20 | pelvic NEAR/2 pain | 17,397 |\n19 | ‘pelvic pain’/exp. OR ‘pelvic pain’ | 20,112 |\n18 | ‘urination disorder’:ti,ab | 46 |\n17 | ‘micturition disorder’/exp. OR ‘micturition disorder’ | 143,105 |\n16 | cystitis:ti,ab | 15,122 |\n15 | bladder:ti,ab | 200,602 |\n14 | ‘bladder disease’/exp. OR ‘bladder disease’ | 168,493 |\n13 | incontinence:ti,ab | 67,242 |\n12 | ‘incontinence’/exp. OR ‘incontinence’ | 107,391 |\n11 | 8 OR 9 OR 10 | 29,033 |\n10 | sacral:ti,ab | 21,699 |\n9 | sacrum:ti,ab | 6670 |\n8 | ‘sacrum’/exp. OR ‘sacrum’ | 12,712 |\n7 | 1 OR 2 OR 3 OR 4 OR 5 OR 6 | 280,338 |\n6 | neurostimulat*:ti,ab | 4112 |\n5 | neuromodulation | 44,386 |\n4 | ‘neuromodulation’/exp. OR ‘neuromodulation’ | 44,386 |\n3 | nerve NEAR/2 stimulation | 70,552 |\n2 | electric NEAR/2 stimulation | 7840 |\n1 | ‘electrotherapy’/exp. OR ‘electrotherapy’ |\nWeb of Science\nTS = (“electric stimulation therapy” OR electric NEAR/2 stimulation OR nerve NEAR/2 stimulation OR neuromodulation* OR neurostimulat*) AND TS = (incontinence OR incontinent OR bladder or cystitis OR “urination disorder*” OR urin* NEAR/2 disorder* OR pelvic pain) AND TS = (sacrum OR sacral))ANDLANGUAGE: (English) AND DOCUMENT TYPES: (Article).\nIndexes = SCI-EXPANDED Timespan = 1988–2018.\nRights and permissions\nAbout this article\nCite this article\nMahran, A., Baaklini, G., Hassani, D. et al. Sacral neuromodulation treating chronic pelvic pain: a meta-analysis and systematic review of the literature. Int Urogynecol J 30, 1023–1035 (2019). https://doi.org/10.1007/s00192-019-03898-w\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00192-019-03898-w","source_license":"CC0","license_restricted":false}