Sacral neuromodulation for chronic pelvic pain related to endometriosis

Sacral neuromodulation (SNM) has established its role in the treatment of urinary urgency incontinence, urinary urgency frequency syndrome, nonobstructive urinary retention, and faecal incontinence. Based on research data and clinical experience, SNM might be effective in the treatment of chronic pelvic pain (CPP). However, the current understanding is that more research data is needed before strong recommendations can be made. Endometriosis is present in 50-80% of women diagnosed with CPP. Endometriosis is associated with significant societal costs and the majority of these (75-84%) are related to loss of productivity. Studies show that even a 10% pain relief improves productivity. Current medical and surgical therapies are beneficial for many endometriosis patients, but in some cases they remain unsatisfactory, probably because they are focused on the treatment of endometriosis lesions. The aim of our first study was to evaluate the role of SNM in CPP patients. We analyzed the data of all the Finnish patients that were treated by SNM (as an off label indication) for CPP between 2004 and 2017 and discovered that SNM’s success rate for endometriosis patients with CPP was significantly higher compared to patients with CPP of other causes: 88% advanced to permanent implantation with an overall success rate of 75%. Encouraged by the results of this retrospective study and by the results of a Finnish case study published in 2017, a multicentre prospective study was launched in 2017. This study involved patients with CPP attributed solely to endometriosis. The positive outcomes suggest that SNM may be considered for treating CPP in endometriosis when other treatments fail. Our third study evaluated the long-term efficacy and safety of SNM for CPP linked to endometriosis after surgery. Results suggest that SNM may help endometriosis patients with CPP who do not respond to common therapies, regardless of endometriosis classification or type of surgical procedures.