Electrical Pudendal Nerve Stimulation as an Initial Neuromodulation Strategy for Neurogenic Urinary Retention

Abstract

Background and objective Chronic neurogenic urinary retention often requires assisted emptying and remains challenging to treat. We evaluated whether electrical pudendal nerve stimulation (EPNS) improves bladder emptying and compared short-term outcomes with a standard sacral neuromodulation (SNM) test stimulation strategy. Methods In this prospective, multicenter, assessor-masked study, 70 adults with chronic refractory neurogenic nonobstructive urinary retention received either EPNS (12 sessions over 4 wk) or a standard 4-wk continuous SNM test phase using a percutaneously placed S3 lead. The primary outcome was the percentage change from baseline in postvoid residual urine volume (PVR) at 4 wk. Secondary outcomes included changes in International Consultation on Incontinence Questionnaire–Lower Urinary Tract Symptoms and Quality of Life scores. Analyses used linear mixed models; propensity score matching was prespecified as a sensitivity analysis. Key findings and limitations At 4 wk, the adjusted PVR improvement rate was 68% with EPNS versus 51% with SNM (between-group difference 17 percentage points; 95% confidence interval 5–29; p = 0.008). Improvements in symptom and quality of life scores also favored EPNS ( p < 0.001 for both). Limitations include nonrandom treatment allocation and short follow-up. Conclusions and clinical implications Outpatient EPNS produced clinically meaningful short-term improvements in bladder emptying and patient-reported outcomes without implantation, supporting consideration of EPNS as an initial step in a stepped neuromodulation pathway for neurogenic urinary retention.