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Interstitial Cystitis - Evaluation of 4 Years Experience
Posters
619. Sacral nerve stimulation for painful bladder syndrome / interstitial cystitis evaluation of 4 years experience R. Reddy, R. Khan, A. Al-Kaisy Guy’s & St.Thomas’ Hospitals NHS Foundation Trust, London, UK Introduction: Painful Bladder Syndrome / Interstitial Cystitis (PBS/IC) is characterized by chronic pelvic pain, dysuria, significant disability and poor quality of life. Management includes conservative measures and surgery which are often unsatisfactory. Sacral nerve stimulation (SNS) has been shown to be extremely beneficial in refractory cases. We are presenting a retrospective evaluation of our 4 years experience with SNS for PBS/IC. Methods: Retrospective data from 14 patients who underwent SNS for PBS/IC from varied etiology, using retrograde (11) and caudal (3) approaches between 2003 and 2007. All patients failed conservative and/or surgical treatments. After full psychological evaluation, trial of SNS was carried out with two Quad leads either by retrograde or caudal approach if they had back surgery. If pain decreased by more than 50% with reduction in voiding frequency, permanent implant was done. We looked at reduction in pain/ frequency/nocturia/analgesics, consistency of stimulation, complications and revisions. Results: All patients showed ⬎ 50% reduction in pain and significant reduction in frequency, 4 had complete absence of nocturia and 10 had ⬎ 50% reduction in analgesic usage. Complications were postdural puncture headache (1), infection at wound site (1), lead revision due to inconsistent stimulation (1) and battery repositioning (1). SNS by both approaches produced consistent stimulation at low voltage to targeted area. Conclusions: SNS produces significant pain relief and reduction in frequency of voiding and analgesic usage thereby reducing disability and improving quality of life compared to other treatments. Advantages of SNS over transforaminal anterograde approach include consistent stimulation of targeted area at low voltage and lead stability. The rates of lead revision and complications are low. SNS is safe and effective in PBS/IC and should be tried before radical surgical interventions.
Reference Al-Kaisy, AA, Baranowski, AP. Neuromodulation in Urogenital pain management Urogenital pain in clinical practice, Ed 2007.
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Chronic Pain Management
201
638. Complications of intrathecal drug delivery system implantation for chronic pain: A retrospective review of 62 patients over 16 years L. Radhakrishnan1, R. Duarte2, H. Mutagi1, S. Kapur1, J. Raphael2 1Russells Hall Hospital, Department of Pain Management, Dudley, UK, 2Birmingham City University, Faculty of Health, Birmingham, UK Introduction: Multiple open studies support the use of intrathecal drug delivery (ITDD) for long-term analgesia and reduce disability. Minor complications are common with ITDD, while serious complications are rare [1]. Due to the rarity of serious complications further long-term data is needed to more confidently quantify these. Aim: With the benefit of one of the longest experiences with ITDD, to contribute to the data on the uncommon but serious complications. Methods: A retrospective case notes review of 62 consecutive ITDD patients to record and categorize complications. Results (see table): An average ITDD duration of 6.7 years (1-16years). The mean age was 58.5 years with slight female preponderance. Acute complications were frequently pharmacological (16%), while late were commonly technical (37%). 27.4% required discontinuing ITDD, revision surgery or explantation. 3 patients had catheter tip granulomas (4.8%). In two cases, a previously unreported prolonged unretrieved fractured catheters was noted, both asymptomatic at 24 and 62 months. Conclusion: This series with the longest reported duration of ITDD therapy for non-malignant pain, the commonest acute complications were transient side-effects of intrathecal medications, while technical complications were the commonest late complications. Our overall complication rate is consistent with previously published data [1]. However, we report higher rate of intrathecal granuloma 4.8% (0.007% per patient year) each detected before any neural-damage, which we believe is explained by heightened awareness and early investigation.
Reference 1. Williams JE etal. Intrathecal pumps for chronic pain; systematic review. Health Technology Assessment 2000; Vol 4(32).
Complications of ITDD in 62 patients over 16 years
619. Sacral nerve stimulation for painful bladder syndrome / interstitial cystitis evaluation of 4 years experience R. Reddy, R. Khan, A. Al-Kaisy Guy’s & St.Thomas’ Hospitals NHS Foundation Trust, London, UK Introduction: Painful Bladder Syndrome / Interstitial Cystitis (PBS/IC) is characterized by chronic pelvic pain, dysuria, significant disability and poor quality of life. Management includes conservative measures and surgery which are often unsatisfactory. Sacral nerve stimulation (SNS) has been shown to be extremely beneficial in refractory cases. We are presenting a retrospective evaluation of our 4 years experience with SNS for PBS/IC. Methods: Retrospective data from 14 patients who underwent SNS for PBS/IC from varied etiology, using retrograde (11) and caudal (3) approaches between 2003 and 2007. All patients failed conservative and/or surgical treatments. After full psychological evaluation, trial of SNS was carried out with two Quad leads either by retrograde or caudal approach if they had back surgery. If pain decreased by more than 50% with reduction in voiding frequency, permanent implant was done. We looked at reduction in pain/ frequency/nocturia/analgesics, consistency of stimulation, complications and revisions. Results: All patients showed ⬎ 50% reduction in pain and significant reduction in frequency, 4 had complete absence of nocturia and 10 had ⬎ 50% reduction in analgesic usage. Complications were postdural puncture headache (1), infection at wound site (1), lead revision due to inconsistent stimulation (1) and battery repositioning (1). SNS by both approaches produced consistent stimulation at low voltage to targeted area. Conclusions: SNS produces significant pain relief and reduction in frequency of voiding and analgesic usage thereby reducing disability and improving quality of life compared to other treatments. Advantages of SNS over transforaminal anterograde approach include consistent stimulation of targeted area at low voltage and lead stability. The rates of lead revision and complications are low. SNS is safe and effective in PBS/IC and should be tried before radical surgical interventions.
Reference Al-Kaisy, AA, Baranowski, AP. Neuromodulation in Urogenital pain management Urogenital pain in clinical practice, Ed 2007.
•
Chronic Pain Management
201
638. Complications of intrathecal drug delivery system implantation for chronic pain: A retrospective review of 62 patients over 16 years L. Radhakrishnan1, R. Duarte2, H. Mutagi1, S. Kapur1, J. Raphael2 1Russells Hall Hospital, Department of Pain Management, Dudley, UK, 2Birmingham City University, Faculty of Health, Birmingham, UK Introduction: Multiple open studies support the use of intrathecal drug delivery (ITDD) for long-term analgesia and reduce disability. Minor complications are common with ITDD, while serious complications are rare [1]. Due to the rarity of serious complications further long-term data is needed to more confidently quantify these. Aim: With the benefit of one of the longest experiences with ITDD, to contribute to the data on the uncommon but serious complications. Methods: A retrospective case notes review of 62 consecutive ITDD patients to record and categorize complications. Results (see table): An average ITDD duration of 6.7 years (1-16years). The mean age was 58.5 years with slight female preponderance. Acute complications were frequently pharmacological (16%), while late were commonly technical (37%). 27.4% required discontinuing ITDD, revision surgery or explantation. 3 patients had catheter tip granulomas (4.8%). In two cases, a previously unreported prolonged unretrieved fractured catheters was noted, both asymptomatic at 24 and 62 months. Conclusion: This series with the longest reported duration of ITDD therapy for non-malignant pain, the commonest acute complications were transient side-effects of intrathecal medications, while technical complications were the commonest late complications. Our overall complication rate is consistent with previously published data [1]. However, we report higher rate of intrathecal granuloma 4.8% (0.007% per patient year) each detected before any neural-damage, which we believe is explained by heightened awareness and early investigation.
Reference 1. Williams JE etal. Intrathecal pumps for chronic pain; systematic review. Health Technology Assessment 2000; Vol 4(32).
Complications of ITDD in 62 patients over 16 years