Neuromodulation is recommended by major international guidelines as a fourth-line treatment in bladder pain syndrome/interstitial cystitis (BPS/IC) patients after failure of behavioural, oral and intravesical pharmacological treatments, including hydrodistension. A non-systematic review of studies identified by electronic search of MEDLINE was performed with no time limitation. A narrative synthesis of the existing evidence regarding the results of sacral, tibial and pudendal nerve stimulation in the management of BPS/IC was developed. Neuromodulation in pelvic chronic pain disorders, including BPS/IC, is a useful tool for refractory patients to conventional treatments. Sacral neuromodulation may be effective in patients with BPS without Hunner's lesions, and the effect seems to be maintained in the mid- and long-term. Posterior tibial nerve stimulation can be offered to patients with BPS/IC in the context of a multidisciplinary approach. When pudendal neuralgia is suspected, selective pudendal nerve stimulation has a high response rate. The aetiology of the pain can influence the outcomes in the mid- and long-term of the different neuromodulation approaches, thus careful diagnosis is recommended.
Therapeutic advances in urology. 2022 Nov 21*** epublish ***
Bárbara Padilla-Fernández, David Hernández-Hernández, David M Castro-Díaz
Department of Urology, Complejo Hospitalario Universitario de Canarias, Carretera La Cuesta, s/n, San Cristóbal de La Laguna 38320, Tenerife, Spain., Department of Urology, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Spain.