The effect of sacral neuromodulation on pudendal nerve function and female sexual function

Authors

  • Brent A. Parnell,

    Corresponding author
    1. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina—Chapel Hill, Chapel Hill, North Carolina
    • Correspondence to: Brent A. Parnell, M.D., Assistant Professor and Division Chief, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Georgia Regents University, 1120 15th Street, BB-7518A, Augusta, GA 30912. E-mail: bparnell@gru.edu

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  • James F. Howard Jr.,

    1. Department of Neurology, University of North Carolina—Chapel Hill, Chapel Hill, North Carolina
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  • Elizabeth J. Geller

    1. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina—Chapel Hill, Chapel Hill, North Carolina
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  • Dirk De Ridder led the peer-review process as the Associate Editor responsible for the paper.
  • Conflict of interest: none.
  • Poster Presentation at the American Urogynecologic Society 32nd Annual Scientific Meeting in Providence, RI. September 2011.

Abstract

Aims

To quantify changes in pudendal nerve function with sacral neuromodulation (SNM). To understand the relationship of pudendal nerve function to SNM treatment response for overactive bladder. To assess the relationship between female sexual function and pudendal nerve function after SNM.

Methods

Women undergoing SNM between January 2010 and May 2011 were enrolled. Baseline pudendal nerve terminal motor latencies (PNTML) were measured bilaterally. Subjects underwent peripheral nerve evaluation (PNE) prior to SNM therapy. PNTML was measured at 1 and 6 weeks after sacral neuromodulator implant. Women who did not undergo permanent implantation were reassessed at the end of the 1-week PNE testing phase. Pelvic floor and sexual function questionnaires were administered at baseline and follow-up to assess pelvic floor and sexual function.

Results

Of 34 women enrolled, 31 were evaluated. Mean age was 67.4 ± 14.2 years with 29/34 (85.3%) treated for refractory overactive bladder. Thirty of 31 (96.7%) went on to a permanent implant. PNE success rate was 73.5% (25/33). Mean PNTML changed from 2.74 ± 0.52 msec at baseline to 2.57 ± 0.50 msec at 6 weeks postop (P = 0.198). Baseline amplitude remained stable at 1 and 6 weeks. At 6 weeks PISQ-12 scores showed improved sexual function (P = 0.034) and PFDI-20 and PFIQ-7 scores showed improved pelvic floor, colorectal and urinary symptoms (P < 0.05).

Conclusions

Women with refractory overactive bladder and non-obstructive urinary retention have abnormal pudendal nerve function, which showed a non-significant trend toward improvement after SNM. Sexually active women undergoing sacral neuromodulation experienced improvement in sexual function. Quality of life improved due to improvement in urinary and colorectal function. Neurourol. Urodynam. 34:456–460, 2015. © 2014 Wiley Periodicals, Inc.

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