Nasim Zabihi

Short-term results of bilateral S2–S4 sacral neuromodulation for the treatment of refractory interstitial cystitis, painful baldder syndrome, and chronic pelvic pain

We evaluated the efficacy of bilateral caudal epidural sacral neuromodulation for the treatment of refractory chronic pelvic pain (CPP), painful bladder syndrome, and interstitial cystitis (IC). Thirty consecutive patients (21 female, 9 male) with severe refractory symptoms underwent bilateral S2–S4 sacral neuromodulation for CPP/IC. Patients were evaluated with the O’Leary IC symptom and problem index (ICSI, ICPI), the short form of the Urogenital Distress Inventory (UDI-6), and the RAND 36-item health survey (SF-36) preoperatively and 6xa0months postoperatively. The mean and minimum follow-up were 15 and 6xa0months, respectively. Of the 30 patients, 23 (77%) had a successful trial stimulation and were permanently implanted. Among these patients, the ICSI and ICPI scores improved by 35 (pu2009=u20090.005) and 38% (pu2009=u20090.007), respectively. The pain score improved by 40% (pu2009=u20090.04) and the UDI-6 score by 26% (pu2009=u20090.05). On average, patients reported a 42% improvement in their symptoms. SF-36 scores did not improve significantly. In refractory patients, bilateral caudal epidural sacral neuromodulation is another possible mode of treatment, which appears to improve both pelvic pain and voiding symptoms.

The effects of bilateral caudal epidural S2–4 neuromodulation on female sexual function

This is a pilot study to evaluate the effects of caudal epidural S2–4 neuromodulation on female sexual function in a population of women with voiding dysfunction. We prospectively studied 36 consecutive female patients who underwent caudal epidural sacral neuromodulation. Patients received the Female Sexual Function Index (FSFI) questionnaire preoperatively and 6xa0months postoperatively. Six months after permanent implantation, the overall score on the FSFI improved by 52% (pxa0=xa00.05). Results were better in patients who underwent the treatment for voiding dysfunction compared to those who had pain as their primary complaint. In this group, the overall score improved by 157% (pxa0=xa00.004). Stimulation of S2–4 by bilateral caudal epidural neuromodulation in this small group of women with voiding dysfunction, retention, and/or pelvic pain resulted in self-reported improvements in sexual function. Further studies are needed to evaluate the potential role of S2–4 sacral stimulation in the treatment of female sexual dysfunction.

Treatment choice, duration, and cost in patients with interstitial cystitis and painful bladder syndrome.

Introduction and hypothesisIn order to better understand provider treatment patterns for interstitial cystitis (IC)/painful bladder syndrome, we sought to document the therapies utilized and their associated expenditures using a national dataset.MethodsA cohort was created by applying the ICD-9 diagnosis of IC (595.1) to INGENIX claims for the year 1999. Subjects were followed for 5xa0years, and patterns of care and related expenditures were evaluated.ResultsOf 553,910 adults insured in 1999, 89 subjects had a diagnosis of IC with 5-year follow-up data. All subjects were treated with oral medication(s), 26% received intravesical treatments, and 22% underwent hydrodistension. Total expenditures per subject were

Bladder Necrosis Following Hydrodistention in Patients With Interstitial Cystitis

2,808.ConclusionsThe majority of IC expenditures were attributable to oral medical therapy. Hydrodistension and intravesical instillations were utilized in less than 25% of patients. Hydrodistension was used more frequently among subjects with a new diagnosis; this may reflect its utilization as part of a diagnostic algorithm.