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

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