Pudendal neuralgia is an often debilitating chronic pain condition. Up to 25% of these patients are refractory to the current treatments including medications, pelvic floor physical therapy, nerve blocks, sacral neuromodulation, and pudendal nerve entrapment surgery, thus indicating a need for alternative treatment modalities. StimWave® is a novel wireless powered nerve stimulator approved for implantation at any peripheral nerve. On demand adjustable frequency stimulation is performed by the patient in order to control peripheral nerve pain. We have developed a minimally invasive percutaneous technique to place the lead adjacent to the pudendal nerve for the treatment of pudendal neuralgia. This video describes the step-by-step technique of transgluteal StimWave® placement at the pudendal nerve.

The video was recorded during both the trial and permanent implant stages of transgluteal StimWave® placement for the treatment of bilateral pudendal neuralgia.

Our institution recently published the results of this novel technique of placing a peripheral nerve stimulator at the pudendal nerve in order to treat pudendal neuralgia (Hoang Roberts 2021). Of the thirteen treatment refractory patients, 10/13 (76.9%) had >50% improvement in pain with 6/13 (46.1%) reporting 100% pain improvement. Post-operatively the patient in this video had an almost 100% resolution of her symptoms.

In this video we demonstrated the step-by-step guide for a surgeon to perform this procedure. When implanted, patients with pudendal neuralgia refractory to the current treatment options can have a significant improvement in pain and increased quality of life.

Hoang Roberts, L, Vollstedt, A, Volin, J, McCartney, T, Peters, KM. Initial experience using a novel nerve stimulator for the management of pudendal neuralgia. Neurourology and Urodynamics. 2021; 40: 1670- 1677. https://doi.org/10.1002/nau.24735

Continence 7S1 (2023) 101017
DOI: 10.1016/j.cont.2023.101017