Good results from Sacral Stimulation

[Amanda]

Here is a great article I found about the positive results being achieved using Stimulation on the Pudendal Nerve.


http://www.pslgroup.com/dg/252906.htm

[Violet M]

Amanda, I've discovered that links tend to become outdated so I'm posting the text of the article here:

Pudendal at Least as Easy and Effective as Sacral Nerve Stimulation for Treatment of Voiding Dysfunction: Presented at ICS

By Alison Palkhivala

MONTREAL, CANADA -- September 6, 2005 -- Stimulating the pudendal nerve in patients with voiding dysfunction appears to be at least as easy, safe, and effective as stimulating the sacral nerve and, when given the choice, most patients preferred pudendal over sacral stimulation.

To compare the benefits of sacral versus pudendal nerve stimulation, Kenneth Peters, MD, William Beaumont Hospital, Royal Oak, Michigan, United States, and colleagues placed a second electrode at the pudendal nerve in 30 patients with voiding dysfunction who were already undergoing implantation of an electrode at the sacral nerve.

The position of the leads was confirmed using radiographs in all patients. Twenty-seven of these patients had urgency, frequency, or incontinence. The other three suffered from urinary retention.

Dr. Peters presented the results here September 1st at the 35th annual meeting of the International Continence Society (ICS).

Patients all received a standard external stimulation box and were randomized in a single-blinded fashion to stimulate either the sacral or pudendal nerve for 7 days, then the other nerve for another 7 days. During each of these 7-day testing periods, patients completed voiding diaries as well as a global response assessment (GRA), which consisted of a 7-point scale on which they rated symptoms of frequency, urgency, pelvic pain, and bowel function.

Overall, 80% of patients reported improvement in symptoms with stimulation of one or other of the nerves. Among these patients, 79% reported better improvement with pudendal stimulation, and the other 21% preferred sacral stimulation. One patient with retention and 5 patients with urgency/frequency had no response to either form of stimulation.

The order in which the lead was stimulated did not have an impact on which form of stimulation patients preferred.

In accordance with patients' preferences, patients' GRA ratings also demonstrated more improvement with pudendal stimulation. Overall, GRA ratings were improved by 51% with pudendal stimulation, compared with 37% with sacral stimulation. Pudendal stimulation also significantly improved GRA scores more than sacral stimulation with respect to pelvic pain, urgency, frequency, and bowel function. There was no difference between the two groups, however, with respect to changes in symptoms of vaginal pain, sexual function, or incontinence.

Voiding diaries revealed that both sacral and pudendal stimulation significantly reduced the number of voids per 24 hours. They also both increased the mean volume of urine and the smallest volume of urine expelled. The two modalities did not differ significantly from each other on these parameters.

"Certainly, it's a very feasible thing -- pudendal stimulation. I don't know that it's a better lead right now," said Dr. Peters. "I think that if each patient didn't experience both electrodes, they may not have chosen this way. They may have been equal."

He believes these findings support the need to continue to explore the effects of stimulation at other nerve sites.

[Presentation title: Sacral vs Pudendal Nerve Stimulation for Voiding Dysfunction: a Prospective, Single Blinded, Randomized Crossover Trial. Abstract 88]

[Grammy]

Did anyone find info on stimulation of the pudendal nerve for pain and pressure

[Grammy]

Amanda--a few more questions that you may be able to answer. I have a horrible feeling all the time of a foreign object in the vagina and the urge to want to put my finger in the vagina and push up. I feel horrible pressure all the time . My condition has been going on for seventeen years as many of you know and I am losing the ability to cope. Somedays I just do nothing all day and I mean nothing. Pain medication certainly helps with the burning but it does nothing for the feeling of distention. I am not sure if you ever posted exactly what your symptoms were and how the stim took care of them. AND this is the big question for anyone out there. If you antagonize the pudendal nerve with electrical stim will you ultimately make the entire condition all the worse for doing so? I really need some help and a sixth surgery is something that I can not seem to face however when I awake each morning my nerves have gotten so bad I am literally sick to my tummy with anxiety. Any suggestions at all will be so appreciated. Gram

[knap]

I, too, have great pressure down there. Once I went to the gynecologist begging him to take out whatever was causing the burning and the pain. I could feel something up in my vaginal canal. it was horrible. he checked me out and said that all looked good. it must be those tricky nerves toward the back. I could not believe it.

[Amanda]

Grammy

I have posted my symptoms many times here on the forum....yes they include the pressing on the vagina and whole pelvic floor of a foreign object being stuck in here there and everywhere, along with severe urination frequency and total constipation.

just to let you know that when you have a stimulator it actually stimulates the nerves as they exit the spine so dont irritate the nerve in situ that is in the pelvic regions. When I had the stimulator originally it did irritate everything, but with adjustments and my brain adjusting to the electrical settings things began to calm down. But as i have many differing areas of pain if I sit on my standing programme which stimulates a totally different area then my pain can get really high...it is so hard to describe. The only thing I can say is that stimulation has given me a definite quality of life that I never dreamed of before...it is not a cure....I dont believe that there is a cure if your nerves are damaged as mine were due to surgery...but any help is great.
I still use ice 24/7 and take the same meds as pre surgery apart from anti inflammatories which have given me stomach problems so while i miss the effect I cant take them so I do use ice more now than years ago. I try to avoid sitting when possible and always take ice with me if I know I have to sit for any period of time. If you want to email me and ask more then please do so.

Best wishes

[Faith]

so where exactly was your sacral stimulator placed? At what nerve root level?

[Faith]

so where exactly was your sacral stimulator placed? At what nerve root level?

[quilter]

Dear Amanda:

I just saw a new pain mgmt anesthesiologist locally who's also been doing pelvic pain treatment. He feels the only thing that may help at this point is neurostimulation (sacral implant of a Medtronic device). Since seeing him and getting the DVDs & info many questions occur. I want to learn as much as possible from patients before talking with him again. At this point we don't know if my pain is a new entrapment at the same or different area than Dr. Hibner operated on (he said entrapped at the left sacrospinous ligament), or gradual failure of that surgery 3-1/2 years ago, ongoing PN, etc. It seems clear the pudendal nerve is still irritated as much of my pain is now the same as preop. I've lost many of the gains I made and sitting tolerance is far less than it was at 1 year postop.

If the neurostim trial works and I'm an implant candidate, does increased sitting tolerance due to improved pain potentially cause ongoing nerve damage if the nerve is still compressed? Or, do I still maintain the physical restrictions, but go through life with less pain and drugs? 12 years ago I got a TENS at about 10 months post-injury, long before PNE diagnosis, and it was what allowed me to get through 8 hours a day of sitting/commuting. Nobody knew what the problem was, so I wasn't told that sitting was causing nerve compression. I continued to sit for years through gritted teeth until pain made me stand or lie down.

How are you doing, and how specifically has the stim helped you to function better? Does having an implanted stim prohibit any particular further PN testing or treatment? Should I try to do whatever tests I can to get a better diagnosis prior to considering stim trial? What other questions do I need to be asking?

Pelvic floor Botox July 2010 was minimally helpful. At that time Dr. Hibner discussed possibly going back in surgically if Botox didn't help, but a few months later he decided I wasn't a good candidate for surgery and has nothing else to offer. I must do something to allow me to return to some kind of work, plus travel. My daughter is now married & living in Europe for the next few years. Seeing them only once a year (or less) just doesn't cut it, especially if they have a baby. Thanks!

[carolynm]

My only comment is that I am disheartend that Dr. Hibner had nothing to offer you. redo surgery? Another Potter MRI? Just thinking here. Did you leave feeling okay or betrayed a little?

cm