Background & Aims

Chronic Bladder Pain Syndrome (CBPS) affects approximately 6% of the global population, predominantly women, presenting as persistent or recurrent pain in the urinary bladder area without a clear aetiology. CBPS frequently co-occurs with negative cognitive, sexual, or emotional consequences and lower urinary tract symptoms. Despite its complex clinical profile, treatment options are limited. Sacral Nerve Stimulation (SNS), typically utilised off-label, has shown potential in treating bladder dysfunctions by modulating neuronal activity. However, evidence from previous reviews highlighted significant limitations due to small sample sizes and retrospective designs, indicating a need for updated and rigorous research. This study aims to re-evaluate the effectiveness of SNS in treating CBPS to provide updated clinical guidance.

Methods

We conducted a meta-analysis of all relevant studies published to date, following a registered PROSPERO protocol with strict inclusion/exclusion criteria. We systematically searched PubMed, Embase and Cochrane databases. Data extraction was standardised, and analysis was performed using RevMan from Cochrane. Primary outcomes included pain score, urgency, frequency, quality of life (QoL) markers, and complications.

Results

A total of 1,415 articles were initially screened, with 17 studies meeting our inclusion criteria. Our findings show a general positive correlation between SNS and CBPS symptom improvement. Despite this, results were not statistically significant, and the evidence base remains weak, predominantly composed of retrospective reviews, case series, or observational studies with a high risk of bias.

Conclusions

Current evidence supporting the use of SNS in CBPS is weak, hindered by methodological flaws and insufficient high-quality randomised controlled trials (RCTs). Our findings underscore the urgent need for well-designed RCTs to definitively assess the efficacy of SNS in treating CBPS. The limited and outdated data from previous reviews call for cautious interpretation of SNS benefits in clinical practice.

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Presenting Author

Rodwan Husein

Poster Authors

Rodwan Husein

MBChB FRCA

Univeristy College London and Cleveland Clinic London

Lead Author

Andrew Baranowski Baranwoski MD FRCA

FFPMRCA

University College London Hospital

Lead Author

Moein Tavvakoli Tavvakoli MD FRCA FFPMRCA

University College London Hospital

Lead Author

Rajvinder Khasriya MRCOG PhD

Eastman Dental Institute, Department of Microbial Diseases, UCL

Lead Author

Rafael Gafoor Gafoor MRCPsych

PhD

University College London

Lead Author

Nicholas Freemantle PhD

University College London

Lead Author

Roman Cregg FRCA FFPMRCA PhD

University College London

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Urogenital Pain