Percutaneous sacral third nerve root neurostimulation improves symptoms anD normalizes urinary HB-EGF levels and antiproliferative activity in patients with interstitial cystitis

Objectives. A highly effective treatment for interstitial cystitis (IC) rem ains elusive. We determined whether sacral third nerve root (S3) percutaneo us neurostimulation (PNS) might be effective in relieving symptoms of IC, a s well as in normalizing urinary factors that are specifically altered in I C. Methods. Six consecutive patients with symptoms and cystoscopic findings co mpatible with IC underwent 5 days of continuous S3 neurostimulation by way of leads placed percutaneously into the S3 foramen. Patients filled out voi ding frequency diaries and pain and urgency questionnaires before PNS and a t the end of PNS when the leads were removed. Urine specimens were collecte d at these two time points and measured for heparin-binding epidermal growt h factor-like growth factor (HB-EGF) by enzyme-linked immunosorbent assay a nd for antiproliferative factor (APF) activity by H-3-thymidine uptake by n ormal human bladder urothelial cells. Results. S3 PNS significantly improved all measured parameters toward norma l values. Voiding frequency decreased twofold from 23.1 +/- 4.6 to 10.6 +/- 4.0 voids daily during PNS (P = 0.0001). Pelvic pain on a scale of 1 to 10 decreased from 7.0 +/- 1.6 to 2.3 +/- 3.2 (P = 0.05). Urinary urgency on a scale of 1 to 10 decreased from 6.0 +/- 2.2 to 1.8 +/- 1.7 (P = 0.02). Uri nary HB-EGF concentration increased sevenfold from 1.5 +/- 2.1 to 11.0 +/- 1.7 ng/mL (P < 0.0001), and urinary APF activity decreased from -76.1% +/- 31% to -4.5% +/- 8.8% (P = 0.005). Conclusions. S3 PNS significantly decreased symptoms and normalized urinary HB-EGF and APF activity in patients with IC. These results suggest that pe rmanent S3 PNS may be beneficial in treating IC. UROLOGY 55: 643-646, 2000. (C) 2000, Elsevier Science Inc.