Superior Hypogastric Plexus Pulsed Radiofrequency Combined With Posterior Tibialis Nerve Transcutaneous Radiofrequency As A Treatment Option Of Chronic Pelvic Pain Management In Interstitial Cystitis

Superior Hypogastric Plexus Pulsed Radiofrequency Combined With Posterior Tibialis Nerve Transcutaneous Radiofrequency As A Treatment Option Of Chronic Pelvic Pain Management In Interstitial Cystitis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Superior Hypogastric Plexus Pulsed Radiofrequency Combined With Posterior Tibialis Nerve Transcutaneous Radiofrequency As A Treatment Option Of Chronic Pelvic Pain Management In Interstitial Cystitis Muhammet Uğur Öztürk, Ayşegül Akyüz Yıldırım, Tuğçe Yavuz Mollavelioğlu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4214919/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose To compare the effectiveness of superior hypogastric plexus pulsed radiofrequency (SHP-PRF) and adjunctive transcutaneous posterior tibial nerve stimulation (TPTNS) in the treatment of patients with interstitial cystitis (IC). Methods Patients diagnosed with IC and performed SHP-PRF treatment were included in this retrospective study. Some of these patients had also undergone TPTNS. Group 1 consisted of patients receiving SHP-PRF and TPTNS treatment. Group 2 consisted of patients receiving SHP-PRF treatment. Patients were evaluated before the interventional procedure and in the 1st and 3rd months after the procedure. Numerical rating scale (NRS), neuropathic pain 4 questions (DN4), the O'Leary-Sant interstitial cystitis symptom index (ICSI), and interstitial cystitis problem index (ICPI) were used as evaluation parameters. Results A total of 34 patients were divided into two groups. In both groups, the results showed significant differences in the NRS, DN4, ICSI, and ICPI scores between the baseline and the 1st month, as well as between the baseline and the 3rd month. (p 0.05). The median of the ICSI score at baseline was significantly higher in group 1 (p 0.05) Conclusion SHP-PRF treatment is a minimally invasive and effective method that can be used to reduce the symptoms and severity of IC. However, the effectiveness of adding TPTNS to the treatment could not be demonstrated. Long-term follow-up, prospective and placebo-controlled studies are needed. CTR number: NCT06256679, registration date: 05.02.2024, retrospectively registered. pulsed radiofrequency treatment urinary bladder diseases hypogastric plexus transcutaneous electric nerve stimulation Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Interstitial cystitis (IC)/painful bladder syndrome (PBS) is a common urological condition, predominantly affecting women, with a prevalence estimated to be between 8% and 29% [ 1 ]. It is characterized by symptoms such as sudden urgency, frequent urination, nocturia, urinary incontinence, pain in the bladder or pelvic region, dyspareunia, and a sense of pressure, which are accompanied by the exclusion of infection and other identifiable pathologies. The exact pathophysiology of IC/PBS is not fully understood, but various mechanisms have been proposed, including chronic inflammation, autoimmune dysregulation, bacterial cystitis, urothelial dysfunction, deficiency of glycosaminoglycan barrier, and urinary cytotoxicity [ 2 ]. The most common pathological findings include urothelial denudation and bladder inflammation. Treatment options for IC/PBS include behavioral modifications, physical therapy, oral medications, intravesical botulinum toxin A injections, sacral neuromodulation for patients unresponsive to conservative treatment, nerve blocks, and cystectomy as a last resort [ 3 ]. The superior hypogastric plexus (SHP) is located bilaterally in the retroperitoneal region between the first sacral vertebra and the fifth lumbar vertebra. It provides innervation to the pelvic and genital regions [ 4 ]. SHP block is performed to control pain in pelvic cancer patients [ 5 ]. Additionally, it is an effective treatment method for non-malignant pelvic pain conditions such as endometriosis, IC, and postoperative adhesions [ 6 ]. Pulsed radiofrequency (PRF) application, providing nondestructive neuromodulation to the SHP, can be used in patients with IC resistant to oral and intravesical treatments [ 7 ]. Posterior tibial nerve stimulation (PTNS) is one form of neuromodulation that uses electrical stimulation to alleviate urinary symptoms [ 8 ]. The posterior tibial nerve is a branch of the sciatic nerve originating from the L5-S3 spinal nerve roots and descends towards the lower extremity. Stimulation of the posterior tibial nerve provides retrograde neuromodulation to the sacral plexus, which controls bladder function. Stimulation can be achieved using a percutaneous needle electrode or a transcutaneous surface electrode [ 8 ]. Studies have shown the effectiveness of both percutaneous and transcutaneous TNS [ 9 ]. Our study aims to evaluate the effectiveness of superior hypogastric plexus pulsed radiofrequency (SHP-PRF) treatment in patients diagnosed with interstitial cystitis and to compare the effectiveness of adding transcutaneous posterior tibial nerve stimulation (TPTNS) to SHP-PRF treatment on pain and symptoms. METHODS Ethical approval for this study was obtained from the Hacettepe University Faculty of Medicine Clinical Research Ethics Committee on December 27, 2022 (Ankara, Turkey, No: GO 22/1328). Between January 2019 and June 2022, a total of 34 patients diagnosed with IC by the urology department and experiencing symptoms for at least 3 months, who had undergone SHP-PRF by our team, were retrospectively included in the study at the Algology Clinic of Hacettepe University Faculty of Medicine. Some of these patients had also undergone TPTNS. Patients aged between 18 and 65 years, diagnosed with IC by the urology department and with at least 3 months of outpatient follow-up, were evaluated. Patients with renal, hepatic, cardiovascular, or psychiatric diseases, pregnant individuals, those who had received additional interventional treatments within the first 3 months after the procedure, those who were not under outpatient follow-up after the procedure, and those with a history of previous surgery or trauma were excluded from the study. Transcutaneous Posterior Tibial Nerve Stimulation Method Two 50x50 mm electrode pads were placed on the posterior-superior aspect of the medial malleolus for posterior tibial nerve stimulation (Fig. 1 ). Stimulation was delivered in continuous mode at a frequency of 20 Hz and a pulsed width of 200 ms. It was applied once a week for 30 min for 4 weeks. The study protocol was determined based on previous TPTNS studies [ 9 , 10 ]. Superior Hypogastric Plexus Pulsed Radiofrequency Method All procedures were performed by a pain specialist. The expected outcomes and possible complications were explained to the patients. Before the intervention, 1000 ml of normal saline was administered intravenously to the patients to prevent hypotension after sympathetic blockade. The patients were positioned prone in the operating room, and a pillow was placed under the abdomen to eliminate the lumbar curve. The patients were monitored, and mild sedation was achieved with 0,05 mg/kg midazolam and 0,5 mg/kg fentanyl. The L5-S1 intervertebral space was visualized using fluoroscopy. A 22G, 15 cm injection needle was advanced along the bilateral disc, and under lateral imaging, the needle position was confirmed anterior to the vertebral bodies (Fig. 2 ). After negative aspiration of blood, 2 ml of contrast solution was injected to confirm the correct needle placement, and then 8 mg of dexamethasone and 40 mg of bupivacaine (0.25%) were injected separately on each side. To prevent discitis, 50 mg of 1 ml cefazolin was injected into the disc, and then the needle was removed [ 5 ]. Patients who were hospitalized for 4–5 hours without any side effects were discharged on the same day. Two weeks later, patients who showed more than 50% improvement from the diagnostic block, as assessed by NRS, underwent a SHP-PRF procedure using a transdiscal technique with a 22G, 15 cm, 10 mm active-tipped radiofrequency needle at 42°C for 120 seconds. No complications were observed during the follow-up. Evaluation Parameters Patients were evaluated three times: before and after the interventional procedure, and at the 1st and 3rd months of follow-up, using numerical rating scale (NRS), neuropathic pain 4 questions (DN4), the O'Leary-Sant interstitial cystitis symptom index (ICSI), and interstitial cystitis problem index (ICPI) assessments. NRS is a scale used to evaluate pain severity between 0–10 [ 11 ]. DN4 is a screening questionnaire to help identify neuropathic pain in clinical practice and research. This leads to a score range of 0–10 when the symptoms (range 0–7 points) as well as the signs (range 0–3 points) items are included [ 12 ]. The ICSI contains 4 items that measure urgency and frequency of urination, nighttime urination, and pain or burning. The ICSI score is is evaluated between 0 and 20 [ 13 ]. ICPI is a form that investigates how much problems the symptoms of interstitial cystitis cause. ICPI score is evaluated between 0 and 16 [ 14 ]. In all parameteres, high score is assosiated with bad result. Statistical Analysis All analyses were carried out with SPSS 25.0 (IBM, USA). The findings of the study are expressed as frequency and percentages. Normality analysis was carried out using the Shapiro-Wilk test. The variables without normal distribution are presented as the median and interquartile range (IQR) with 25th -75th percentiles while variables with normal distribution are expressed as median and standard deviation. Categorical variables were compared with the Chi-square test. According to the percentage of expected counts, Yates continuity correction was applied. Numerical variables with and without normal distribution were compared using the independent samples t-test and Mann-Whitney U. Paired samples without normal distribution were analyzed with the Wilcoxon signed-rank tests. Spearman correlation analysis was performed to find out correlations between variables such as age, gender, and improvement in pain scales, ICSI, and ICPI scores. p 0.05), (Table 1 ). NRS, DN4, and ICPI scores at baseline, 1st, and 3rd months were similar between the groups (p > 0.05). Therefore, the median of the ICSI score at baseline was significantly higher in group 1 (p 0.05) (Table Table 1 Demographic characteristics of groups Variables Group 1 (SHP-RF and TTNS) (n = 19) Group 2 (SHP-RF) (n = 15) p n (%) n (%) Age Mean (SD) 45.63 (9.80) 52.50 (10.53) 0.063† Gender Female 16 (84.2%) 9 (60%) 0.183‡ Additional Diseases Hypertension 5 (26.3%) 3 (20%) 0.254 Type II diabetes mellitus 3 (15.7%) 2 (13.3%) Medications Pregabalin 2 (10.5%) 4 (26.6%) Gabapentin 1 (5.3%) 1 (6.6%) Duloxetine 7 (36.8%) 6 (40%) Pregabalin and duloxetine 4 (21.1%) 3 (20%) Gabapentin and duloxetine 5 (26.3%) 1 (6.6%) †Independent samples t-test, ‡Chi-square test with Yates correction, SD: Standard deviation. Table 2 Comparison of groups according to clinic evaluation parameters Variables Group 1 (SHP-RF and TPTNS) (n = 19) Group 2 (SHP-RF) (n = 15) p Median (Interquartile Range) NRS Baseline 9.0 (8.0–10.0) 8.0 (7.0–10.0) 0.339⁕ 1st month 4.0 (3.0–6.0) 4.0 (4.0-4.3) 0.843⁕ 3rd month 4.0 (3.0–6.0) 3.0 (3.0-3.5) 0.397⁕ DN4 Baseline 4.0 (3.0–6.0) 6.0 (4.0–6.0) 0.114⁕ 1st month 2.0 (2.0–4.0) 2.5 (2.0-4.3) 0.461⁕ 3rd month 2.0 (1.0–4.0) 3.0 (2.8–3.3) 0.226⁕ ICSI Baseline 16.0 (12.0–18.0) 9.5 (8.0–14.0) < 0.01⁕ 1st month 6.0 (4.0–10.0) 6.0 (4.0-7.3) 0.627⁕ 3rd month 6.0 (4.0–8.0) 5.5 (4.0–9.0) 0.788⁕ ICPI Baseline 12.0 (10.0–16.0) 10.5 (8.8–13.0) 0.304⁕ 1st month 6.0 (3.0–7.0) 5.0 (3.0-7.3) 0.706⁕ 3rd month 6.0 (3.0–8.0) 6.0 (4.0-8.3) 0.577⁕ ⁕ Mann-Whitney U test. SHP-PRF: Superior hypogastric plexus pulsed radiofrequency, TPTNS: Transcutaneous posterior tibial nerve stimulation NRS: Numerical rating scale, DN4: Neuropathic pain 4 questions, ICSI: Interstitial cystitis symptom index, ICPI: Interstitial cystitis problem index. For group 1 NRS, DN4, ICSI, and ICPI scores were significantly different between baseline-1st month, and between baseline-3rd month (p 0.05). For group 2, NRS, DN4, ICSI, and ICPI scores were significantly different between baseline-1st month, and between baseline-3rd month (p 0.05) (Table 3 ). Because of the small number of cases, ANOVA analysis could not be made to detect group effects on the change of pain scales and functional evaluation scores over time. The age and gender variables were not associated with a 50% improvement in NRS and DN4 scores, and the amount of decrease in ICSI and ICPI scores by Spearman correlation (p > 0.05). Table 3 Comparison of the Clinical Evaluation Scores in Follow-up for Both Groups Variables Group 1 Group 2 p† p† NRS Baseline − 1st month < 0.001 < 0.01 Baseline − 3rd month < 0.001 < 0.01 1st month − 3rd month 0.977 0.326 DN4 Baseline − 1st month < 0.001 < 0.01 Baseline − 3rd month < 0.001 < 0.01 1st month − 3rd month 0.414 0.834 ICSI Baseline − 1st month < 0.001 < 0.01 Baseline − 3rd month < 0.001 < 0.01 1st month − 3rd month 0.997 0.963 ICPI Baseline − 1st month < 0.001 < 0.01 Baseline − 3rd month < 0.001 < 0.01 1st month − 3rd month 0.883 0.018 †Wilcoxon signed ranks test. NRS: Numerical rating scale, DN4: Neuropathic pain 4 questions, ICSI: Interstitial cystitis symptom index, ICPI: Interstitial cystitis problem index. DISCUSSION In this study, we evaluated the effectiveness of SHP-PRF treatment and the additional TPTNS treatment in patients with IC/PBS who were resistant to medical therapy, using DN4, NRS, ICSI, and ICPI. In both groups, NRS, DN4, ICSI, and ICPI values significantly decreased compared to baseline after the procedure and during the 3 month follow-up period. However, the effectiveness of TPTNS treatment added to SHP-PRF treatment could not be demonstrated. The pathophysiology and treatment of IC/PBS have not yet reached a consensus despite intensive research. The main goal is to maintain the quality of life at an optimal level and minimize symptom severity [ 5 ]. SHP-PRF treatment, which provides non-destructive neuromodulation to the pelvic visceral pain mediated by the superior hypogastric plexus, is a method that can be used in interstitial cystitis patients resistant to oral and intravesical treatments [ 7 ]. Similarly, percutaneous posterior tibial nerve stimulation (PPTNS) is an FDA-approved treatment method for symptoms such as urinary incontinence, sensation of pressure, and urgency in IC/PBS patients [ 8 ]. Different studies have shown similar effectiveness between PPTNS and TPTNS treatments. When we look at similar studies; In the review published by Urits et al., superior hypogastric plexus blockade application in chronic pelvic pain was examined and it was shown that it provided long-term relief in 50–70% of the patients who underwent the procedure. It was stated that there was no difference between transdiscal or classical method [ 15 ]. We also use the transdiscal method in our routine practice. According to the literature, there is only one case report of SHP-PRF application in patients with IC/PBS. It was observed that the application of SHP-PRF treatment to a female patient diagnosed with IC/PBS relieved pain and symptoms for 2 years and 6 months. It has been reported that PRF treatment of the superior hypogastric plexus may lead to long-term improvement in pain and symptoms associated with IC [ 7 ]. Performing neurolysis with alcohol or phenol in non-cancer pelvic pain can pose risks in terms of Wallerian degeneration or neuroma formation. Therefore, SHP-PRF treatment is an alternative method that can be considered for non-cancer pelvic pain [ 7 ]. We also applied SHP-PRF in our patients diagnosed with IC/PBS due to its longer-lasting effectiveness and lower risk. We did not observe any significant side effects in our patients. In a study conducted by Kabay et al., 39 female patients diagnosed with IC/PBS received PPTNS treatment once a week for 30 minutes for 12 weeks. The patients were evaluated using VAS, ICSI, and ICPI before and after the treatment, and a significant decrease in scores was observed. As a result, it was reported that the 12-week PPTNS treatment was beneficial in relieving IC/PBS symptoms and is a first-line treatment optional [ 16 ]. In a study by Garcia et al., 68 patients diagnosed with IC/PBS were divided into two groups and received PPTNS and TPTNS. In both groups, urge incontinence episodes decreased by 50%, and no significant difference in effectiveness was found between the two groups. However, they suggested that transcutaneous stimulation could be used more due to its easy application and patient compliance [ 10 ]. In a study by Sonmez et al., 60 IC/PBS patients were divided into three groups. The first group performed only bladder exercises, the second group performed bladder exercises combined with PPTNS, and the third group performed bladder exercises combined with TPTNS. The results showed that both PPTNS combined with bladder exercises and TPTNS combined with bladder exercises were effective, and both forms of tibial nerve stimulation were clinically similar in terms of efficacy. However, they noted that TPTNS had a shorter preparation time, less discomfort, and higher patient satisfaction compared to PPTNS [ 9 ]. These and similar studies have indicated that TPTNS is as effective as PPTNS in reducing symptoms and may be an option for patients who dislike needle procedures [ 8 , 17 ]. In our study, we used TPTNS, which has similar efficacy, because it is easier to use and more comfortable for the patient. The limitations of our study such as the small number of patients, 3 month follow-up period, and the fact that TPTNS was performed for only 4 weeks may be the reason for this. To our best notice, it is the first study that combined SHP-PRF and TPTNS treatment in patients with interstitial cystitis. In addition, there are few studies in which SHP-PRF treatment was applied to patients with IC/PBS. We think that our study will guide other studies in terms of SHP-PRF and TPTNS applications in IC/PBS patients. CONCLUSION In conclusion, SHP-PRF treatment is a minimally invasive and effective treatment option for reducing symptoms and severity in patients with IC/PBS who are resistant to medical therapy. Although the effectiveness of TPTNS was not demonstrated in this study, further research with larger sample sizes and longer follow-up periods is needed to fully evaluate its efficacy. Declarations ETHICAL APPROVAL This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Hacettepe University Ethics Committee (Date. No: GO 22/1328). FINANCIAL INTERESTS The authors declare they have no financial interests. COMPETING INTEREST The authors have no competing interests to declare that are relevant to the content of this article. PATIENTS’ CONSENT Informed consent was obtained from all individual participants included in the study. 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First-line treatment posterior tibial nerve stimulation in patients with interstitial cystitis/bladder pain syndrome. Central European Journal of Urology. 2021;74(2):208. https://doi.org/10.5173/ceju.2021.0372 Daly CM, Loi L, Booth J, Saidan D, Guerrero K, Tyagi V. Self-management of overactive bladder at home using transcutaneous tibial nerve stimulation: a qualitative study of women’s experiences. BMC Women's Health. 2021;21:1–9. https://doi.org/10.1186/s12905-021-01522-y Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nalan","middleName":"","lastName":"Çelebi","suffix":""}],"badges":[],"createdAt":"2024-04-03 22:14:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4214919/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4214919/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54449660,"identity":"15aa01e2-9552-458c-aff7-f75badd45f79","added_by":"auto","created_at":"2024-04-10 17:39:20","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":49458,"visible":true,"origin":"","legend":"\u003cp\u003eTranscutaneous posterior tibial nerve stimulation method\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4214919/v1/d845c7b7f9c7ea19209ace90.jpg"},{"id":54449661,"identity":"2570c2ec-7f77-4597-99b2-318b8470f37c","added_by":"auto","created_at":"2024-04-10 17:39:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":16025,"visible":true,"origin":"","legend":"\u003cp\u003eSuperior hypogastric plexus pulsed radiofrequency method\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4214919/v1/ad3f84ccaeb782ce4d6df697.png"},{"id":54449662,"identity":"b7a532a8-4e85-422c-b7e7-84262e3d3983","added_by":"auto","created_at":"2024-04-10 17:39:20","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":37549,"visible":true,"origin":"","legend":"\u003cp\u003eStudy flow diagram\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4214919/v1/782fcfc8982457d3e3e6ddbc.png"},{"id":54788473,"identity":"bb00f2db-57e0-4207-9072-07f1bc0d64f6","added_by":"auto","created_at":"2024-04-16 19:44:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":455141,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4214919/v1/e727579e-7888-489c-9b4f-7a2047ff6e94.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Superior Hypogastric Plexus Pulsed Radiofrequency Combined With Posterior Tibialis Nerve Transcutaneous Radiofrequency As A Treatment Option Of Chronic Pelvic Pain Management In Interstitial Cystitis","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eInterstitial cystitis (IC)/painful bladder syndrome (PBS) is a common urological condition, predominantly affecting women, with a prevalence estimated to be between 8% and 29% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is characterized by symptoms such as sudden urgency, frequent urination, nocturia, urinary incontinence, pain in the bladder or pelvic region, dyspareunia, and a sense of pressure, which are accompanied by the exclusion of infection and other identifiable pathologies. The exact pathophysiology of IC/PBS is not fully understood, but various mechanisms have been proposed, including chronic inflammation, autoimmune dysregulation, bacterial cystitis, urothelial dysfunction, deficiency of glycosaminoglycan barrier, and urinary cytotoxicity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The most common pathological findings include urothelial denudation and bladder inflammation. Treatment options for IC/PBS include behavioral modifications, physical therapy, oral medications, intravesical botulinum toxin A injections, sacral neuromodulation for patients unresponsive to conservative treatment, nerve blocks, and cystectomy as a last resort [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe superior hypogastric plexus (SHP) is located bilaterally in the retroperitoneal region between the first sacral vertebra and the fifth lumbar vertebra. It provides innervation to the pelvic and genital regions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. SHP block is performed to control pain in pelvic cancer patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Additionally, it is an effective treatment method for non-malignant pelvic pain conditions such as endometriosis, IC, and postoperative adhesions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Pulsed radiofrequency (PRF) application, providing nondestructive neuromodulation to the SHP, can be used in patients with IC resistant to oral and intravesical treatments [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePosterior tibial nerve stimulation (PTNS) is one form of neuromodulation that uses electrical stimulation to alleviate urinary symptoms [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The posterior tibial nerve is a branch of the sciatic nerve originating from the L5-S3 spinal nerve roots and descends towards the lower extremity. Stimulation of the posterior tibial nerve provides retrograde neuromodulation to the sacral plexus, which controls bladder function. Stimulation can be achieved using a percutaneous needle electrode or a transcutaneous surface electrode [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Studies have shown the effectiveness of both percutaneous and transcutaneous TNS [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study aims to evaluate the effectiveness of superior hypogastric plexus pulsed radiofrequency (SHP-PRF) treatment in patients diagnosed with interstitial cystitis and to compare the effectiveness of adding transcutaneous posterior tibial nerve stimulation (TPTNS) to SHP-PRF treatment on pain and symptoms.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e for this study was obtained from the Hacettepe University Faculty of Medicine Clinical Research Ethics Committee on December 27, 2022 (Ankara, Turkey, No: GO 22/1328).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eBetween January 2019 and June 2022, a total of 34 patients diagnosed with IC by the urology department and experiencing symptoms for at least 3 months, who had undergone SHP-PRF by our team, were retrospectively included in the study at the Algology Clinic of Hacettepe University Faculty of Medicine. Some of these patients had also undergone TPTNS. Patients aged between 18 and 65 years, diagnosed with IC by the urology department and with at least 3 months of outpatient follow-up, were evaluated. Patients with renal, hepatic, cardiovascular, or psychiatric diseases, pregnant individuals, those who had received additional interventional treatments within the first 3 months after the procedure, those who were not under outpatient follow-up after the procedure, and those with a history of previous surgery or trauma were excluded from the study.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eTranscutaneous Posterior Tibial Nerve Stimulation Method\u003c/h2\u003e \u003cp\u003eTwo 50x50 mm electrode pads were placed on the posterior-superior aspect of the medial malleolus for posterior tibial nerve stimulation (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Stimulation was delivered in continuous mode at a frequency of 20 Hz and a pulsed width of 200 ms. It was applied once a week for 30 min for 4 weeks. The study protocol was determined based on previous TPTNS studies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSuperior Hypogastric Plexus Pulsed Radiofrequency Method\u003c/h2\u003e \u003cp\u003eAll procedures were performed by a pain specialist. The expected outcomes and possible complications were explained to the patients. Before the intervention, 1000 ml of normal saline was administered intravenously to the patients to prevent hypotension after sympathetic blockade. The patients were positioned prone in the operating room, and a pillow was placed under the abdomen to eliminate the lumbar curve. The patients were monitored, and mild sedation was achieved with 0,05 mg/kg midazolam and 0,5 mg/kg fentanyl. The L5-S1 intervertebral space was visualized using fluoroscopy. A 22G, 15 cm injection needle was advanced along the bilateral disc, and under lateral imaging, the needle position was confirmed anterior to the vertebral bodies (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e). After negative aspiration of blood, 2 ml of contrast solution was injected to confirm the correct needle placement, and then 8 mg of dexamethasone and 40 mg of bupivacaine (0.25%) were injected separately on each side. To prevent discitis, 50 mg of 1 ml cefazolin was injected into the disc, and then the needle was removed [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Patients who were hospitalized for 4\u0026ndash;5 hours without any side effects were discharged on the same day. Two weeks later, patients who showed more than 50% improvement from the diagnostic block, as assessed by NRS, underwent a SHP-PRF procedure using a transdiscal technique with a 22G, 15 cm, 10 mm active-tipped radiofrequency needle at 42\u0026deg;C for 120 seconds. No complications were observed during the follow-up.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation Parameters\u003c/h2\u003e \u003cp\u003ePatients were evaluated three times: before and after the interventional procedure, and at the 1st and 3rd months of follow-up, using numerical rating scale (NRS), neuropathic pain 4 questions (DN4), the O'Leary-Sant interstitial cystitis symptom index (ICSI), and interstitial cystitis problem index (ICPI) assessments.\u003c/p\u003e \u003cp\u003eNRS is a scale used to evaluate pain severity between 0\u0026ndash;10 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. DN4 is a screening questionnaire to help identify neuropathic pain in clinical practice and research. This leads to a score range of 0\u0026ndash;10 when the symptoms (range 0\u0026ndash;7 points) as well as the signs (range 0\u0026ndash;3 points) items are included [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The ICSI contains 4 items that measure urgency and frequency of urination, nighttime urination, and pain or burning. The ICSI score is is evaluated between 0 and 20 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. ICPI is a form that investigates how much problems the symptoms of interstitial cystitis cause. ICPI score is evaluated between 0 and 16 [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In all parameteres, high score is assosiated with bad result.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll analyses were carried out with SPSS 25.0 (IBM, USA). The findings of the study are expressed as frequency and percentages. Normality analysis was carried out using the Shapiro-Wilk test. The variables without normal distribution are presented as the median and interquartile range (IQR) with 25th -75th percentiles while variables with normal distribution are expressed as median and standard deviation. Categorical variables were compared with the Chi-square test. According to the percentage of expected counts, Yates continuity correction was applied. Numerical variables with and without normal distribution were compared using the independent samples t-test and Mann-Whitney U. Paired samples without normal distribution were analyzed with the Wilcoxon signed-rank tests. Spearman correlation analysis was performed to find out correlations between variables such as age, gender, and improvement in pain scales, ICSI, and ICPI scores. p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was accepted for statistical significance value.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe flow diagram of the groups is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The groups were similar in age, gender and additional diseases (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). NRS, DN4, and ICPI scores at baseline, 1st, and 3rd months were similar between the groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Therefore, the median of the ICSI score at baseline was significantly higher in group 1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), but ICSI scores in 1st and 3rd months were not significantly different (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003cp\u003e(SHP-RF and TTNS)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003cp\u003e(SHP-RF)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.63 (9.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.50 (10.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.063\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (84.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.183\u0026Dagger;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdditional Diseases\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.254\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType II diabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (15.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregabalin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (10.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (26.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGabapentin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuloxetine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (36.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregabalin and duloxetine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGabapentin and duloxetine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026dagger;Independent samples t-test, \u0026Dagger;Chi-square test with Yates correction, SD: Standard deviation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of groups according to clinic evaluation parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003cp\u003e(SHP-RF and TPTNS)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003cp\u003e(SHP-RF)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMedian (Interquartile Range)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNRS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.0 (8.0\u0026ndash;10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.0 (7.0\u0026ndash;10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.339⁕\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.0 (3.0\u0026ndash;6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.0 (4.0-4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.843⁕\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.0 (3.0\u0026ndash;6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.0 (3.0-3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.397⁕\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDN4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.0 (3.0\u0026ndash;6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.0 (4.0\u0026ndash;6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.114⁕\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.0 (2.0\u0026ndash;4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.5 (2.0-4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.461⁕\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.0 (1.0\u0026ndash;4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.0 (2.8\u0026ndash;3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.226⁕\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eICSI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.0 (12.0\u0026ndash;18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.5 (8.0\u0026ndash;14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01⁕\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.0 (4.0\u0026ndash;10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.0 (4.0-7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.627⁕\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.0 (4.0\u0026ndash;8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.5 (4.0\u0026ndash;9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.788⁕\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eICPI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.0 (10.0\u0026ndash;16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.5 (8.8\u0026ndash;13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.304⁕\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.0 (3.0\u0026ndash;7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.0 (3.0-7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.706⁕\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.0 (3.0\u0026ndash;8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.0 (4.0-8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.577⁕\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e⁕ Mann-Whitney U test. SHP-PRF: Superior hypogastric plexus pulsed radiofrequency, TPTNS: Transcutaneous posterior tibial nerve stimulation NRS: Numerical rating scale, DN4: Neuropathic pain 4 questions, ICSI: Interstitial cystitis symptom index, ICPI: Interstitial cystitis problem index.\u003c/p\u003e \u003cp\u003eFor group 1 NRS, DN4, ICSI, and ICPI scores were significantly different between baseline-1st month, and between baseline-3rd month (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); but no significant differences were found between 1st and 3rd month scores (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). For group 2, NRS, DN4, ICSI, and ICPI scores were significantly different between baseline-1st month, and between baseline-3rd month (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01); but except for ICPI scores for which 1st and 3rd month scores were different, no significant differences were found between 1st and 3rd month scores (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Because of the small number of cases, ANOVA analysis could not be made to detect group effects on the change of pain scales and functional evaluation scores over time.\u003c/p\u003e \u003cp\u003eThe age and gender variables were not associated with a 50% improvement in NRS and DN4 scores, and the amount of decrease in ICSI and ICPI scores by Spearman correlation (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the Clinical Evaluation Scores in Follow-up for Both Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026dagger;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u0026dagger;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNRS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline \u0026minus;\u0026thinsp;1st month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline \u0026minus;\u0026thinsp;3rd month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st month \u0026minus;\u0026thinsp;3rd month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDN4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline \u0026minus;\u0026thinsp;1st month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline \u0026minus;\u0026thinsp;3rd month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st month \u0026minus;\u0026thinsp;3rd month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.834\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eICSI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline \u0026minus;\u0026thinsp;1st month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline \u0026minus;\u0026thinsp;3rd month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st month \u0026minus;\u0026thinsp;3rd month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eICPI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline \u0026minus;\u0026thinsp;1st month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline \u0026minus;\u0026thinsp;3rd month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st month \u0026minus;\u0026thinsp;3rd month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.883\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026dagger;Wilcoxon signed ranks test. NRS: Numerical rating scale, DN4: Neuropathic pain 4 questions, ICSI: Interstitial cystitis symptom index, ICPI: Interstitial cystitis problem index.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, we evaluated the effectiveness of SHP-PRF treatment and the additional TPTNS treatment in patients with IC/PBS who were resistant to medical therapy, using DN4, NRS, ICSI, and ICPI. In both groups, NRS, DN4, ICSI, and ICPI values significantly decreased compared to baseline after the procedure and during the 3 month follow-up period. However, the effectiveness of TPTNS treatment added to SHP-PRF treatment could not be demonstrated.\u003c/p\u003e \u003cp\u003eThe pathophysiology and treatment of IC/PBS have not yet reached a consensus despite intensive research. The main goal is to maintain the quality of life at an optimal level and minimize symptom severity [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSHP-PRF treatment, which provides non-destructive neuromodulation to the pelvic visceral pain mediated by the superior hypogastric plexus, is a method that can be used in interstitial cystitis patients resistant to oral and intravesical treatments [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Similarly, percutaneous posterior tibial nerve stimulation (PPTNS) is an FDA-approved treatment method for symptoms such as urinary incontinence, sensation of pressure, and urgency in IC/PBS patients [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Different studies have shown similar effectiveness between PPTNS and TPTNS treatments.\u003c/p\u003e \u003cp\u003e When we look at similar studies; In the review published by Urits et al., superior hypogastric plexus blockade application in chronic pelvic pain was examined and it was shown that it provided long-term relief in 50\u0026ndash;70% of the patients who underwent the procedure. It was stated that there was no difference between transdiscal or classical method [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. We also use the transdiscal method in our routine practice. According to the literature, there is only one case report of SHP-PRF application in patients with IC/PBS. It was observed that the application of SHP-PRF treatment to a female patient diagnosed with IC/PBS relieved pain and symptoms for 2 years and 6 months. It has been reported that PRF treatment of the superior hypogastric plexus may lead to long-term improvement in pain and symptoms associated with IC [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Performing neurolysis with alcohol or phenol in non-cancer pelvic pain can pose risks in terms of Wallerian degeneration or neuroma formation. Therefore, SHP-PRF treatment is an alternative method that can be considered for non-cancer pelvic pain [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. We also applied SHP-PRF in our patients diagnosed with IC/PBS due to its longer-lasting effectiveness and lower risk. We did not observe any significant side effects in our patients.\u003c/p\u003e \u003cp\u003eIn a study conducted by Kabay et al., 39 female patients diagnosed with IC/PBS received PPTNS treatment once a week for 30 minutes for 12 weeks. The patients were evaluated using VAS, ICSI, and ICPI before and after the treatment, and a significant decrease in scores was observed. As a result, it was reported that the 12-week PPTNS treatment was beneficial in relieving IC/PBS symptoms and is a first-line treatment optional [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In a study by Garcia et al., 68 patients diagnosed with IC/PBS were divided into two groups and received PPTNS and TPTNS. In both groups, urge incontinence episodes decreased by 50%, and no significant difference in effectiveness was found between the two groups. However, they suggested that transcutaneous stimulation could be used more due to its easy application and patient compliance [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn a study by Sonmez et al., 60 IC/PBS patients were divided into three groups. The first group performed only bladder exercises, the second group performed bladder exercises combined with PPTNS, and the third group performed bladder exercises combined with TPTNS. The results showed that both PPTNS combined with bladder exercises and TPTNS combined with bladder exercises were effective, and both forms of tibial nerve stimulation were clinically similar in terms of efficacy. However, they noted that TPTNS had a shorter preparation time, less discomfort, and higher patient satisfaction compared to PPTNS [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These and similar studies have indicated that TPTNS is as effective as PPTNS in reducing symptoms and may be an option for patients who dislike needle procedures [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In our study, we used TPTNS, which has similar efficacy, because it is easier to use and more comfortable for the patient.\u003c/p\u003e \u003cp\u003eThe limitations of our study such as the small number of patients, 3 month follow-up period, and the fact that TPTNS was performed for only 4 weeks may be the reason for this.\u003c/p\u003e \u003cp\u003eTo our best notice, it is the first study that combined SHP-PRF and TPTNS treatment in patients with interstitial cystitis. In addition, there are few studies in which SHP-PRF treatment was applied to patients with IC/PBS. We think that our study will guide other studies in terms of SHP-PRF and TPTNS applications in IC/PBS patients.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn conclusion, SHP-PRF treatment is a minimally invasive and effective treatment option for reducing symptoms and severity in patients with IC/PBS who are resistant to medical therapy. Although the effectiveness of TPTNS was not demonstrated in this study, further research with larger sample sizes and longer follow-up periods is needed to fully evaluate its efficacy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eETHICAL APPROVAL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Hacettepe University Ethics Committee (Date. No: GO 22/1328).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFINANCIAL INTERESTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare they have no financial interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOMPETING INTEREST\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePATIENTS\u0026rsquo; CONSENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was presented as an oral presentation at the 17th National Pain Congress. 04-07.May.2023.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eIyer S, Laus K, Rugino A, Botros C, Lozo S, Botros SM, et al. 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Neurourology and Urodynamics. 2020;39(8):2338\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/nau.24492\u003c/span\u003e\u003cspan address=\"10.1002/nau.24492\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUrits I, Schwartz R, Herman J, Berger AA, Lee D, Lee C, et al. A comprehensive update of the superior hypogastric block for the management of chronic pelvic pain. Current Pain and Headache Reports. 2021;25:1\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11916-020-00933-0\u003c/span\u003e\u003cspan address=\"10.1007/s11916-020-00933-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKabay S, Kabay SC, Sevim M. First-line treatment posterior tibial nerve stimulation in patients with interstitial cystitis/bladder pain syndrome. Central European Journal of Urology. 2021;74(2):208. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5173/ceju.2021.0372\u003c/span\u003e\u003cspan address=\"10.5173/ceju.2021.0372\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDaly CM, Loi L, Booth J, Saidan D, Guerrero K, Tyagi V. Self-management of overactive bladder at home using transcutaneous tibial nerve stimulation: a qualitative study of women\u0026rsquo;s experiences. BMC Women's Health. 2021;21:1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12905-021-01522-y\u003c/span\u003e\u003cspan address=\"10.1186/s12905-021-01522-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"pulsed radiofrequency treatment, urinary bladder diseases, hypogastric plexus, transcutaneous electric nerve stimulation","lastPublishedDoi":"10.21203/rs.3.rs-4214919/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4214919/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo compare the effectiveness of superior hypogastric plexus pulsed radiofrequency (SHP-PRF) and adjunctive transcutaneous posterior tibial nerve stimulation (TPTNS) in the treatment of patients with interstitial cystitis (IC).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003ePatients diagnosed with IC and performed SHP-PRF treatment were included in this retrospective study. Some of these patients had also undergone TPTNS. Group 1 consisted of patients receiving SHP-PRF and TPTNS treatment. Group 2 consisted of patients receiving SHP-PRF treatment. Patients were evaluated before the interventional procedure and in the 1st and 3rd months after the procedure. Numerical rating scale (NRS), neuropathic pain 4 questions (DN4), the O'Leary-Sant interstitial cystitis symptom index (ICSI), and interstitial cystitis problem index (ICPI) were used as evaluation parameters.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 34 patients were divided into two groups. In both groups, the results showed significant differences in the NRS, DN4, ICSI, and ICPI scores between the baseline and the 1st month, as well as between the baseline and the 3rd month. (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). NRS, DN4, and ICPI scores at baseline, 1st\u003csup\u003e,\u003c/sup\u003e and 3rd months were similar between the groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The median of the ICSI score at baseline was significantly higher in group 1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), but ICSI scores in 1st and 3rd months were not significantly different (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05)\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSHP-PRF treatment is a minimally invasive and effective method that can be used to reduce the symptoms and severity of IC. However, the effectiveness of adding TPTNS to the treatment could not be demonstrated. Long-term follow-up, prospective and placebo-controlled studies are needed.\u003c/p\u003e\u003ch2\u003eCTR number:\u003c/h2\u003e \u003cp\u003eNCT06256679, registration date: 05.02.2024, retrospectively registered.\u003c/p\u003e","manuscriptTitle":"Superior Hypogastric Plexus Pulsed Radiofrequency Combined With Posterior Tibialis Nerve Transcutaneous Radiofrequency As A Treatment Option Of Chronic Pelvic Pain Management In Interstitial Cystitis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-10 17:39:15","doi":"10.21203/rs.3.rs-4214919/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"503839e2-118b-4f0c-b8f2-0b016fe0eab4","owner":[],"postedDate":"April 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-16T19:44:22+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-10 17:39:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4214919","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4214919","identity":"rs-4214919","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}