Bosch J L, Groen J
Department of Urology, Academic Hospital and Erasmus University Rotterdam, The Netherlands.
J Urol. 2000 Apr;163(4):1219-22.
Conservative treatment rarely results in a durable cure of patients with urge incontinence and bladder overactivity. Instrumental and surgical procedures often have significant side effects and less than optimal results. We developed a technique of sacral nerve neuromodulation using chronic unilateral electrical stimulation of the S3 sacral nerve to inhibit the micturition reflex to provide effective nondestructive alternative therapy for patients whose condition is refractory to conservative treatment.
Of 85 patients 45 who responded to a test with a temporary electrode underwent implantation of a permanent S3 sacral nerve electrode coupled to a pulse generator. Treatment results were evaluated by urodynamic studies and voiding/incontinence diaries documenting pad use, incontinence episodes, voiding frequency and voided volume. Partial success and cure were defined as 50% to 90% and more than 90% improvement, respectively, in pad use and/or incontinence episodes.
Of 45 patients 18 (40%) were cured at an average followup of 47.1 months and 9 (20%) achieved partial success. Median number of pads used and median number of incontinence episodes daily had decreased from 5.4 to 1.2 (p = 0.0001) and 7.1 to 1.3 (p = 0.0001), respectively, 6 months after implantation. Subsequently these results remained almost constant for 5 years. Bladder overactivity disappeared in 19 of the 44 patients (43%). The repeat intervention rate was 37.7% and there was no permanent injury or nerve damage.
Sacral nerve neuromodulation is safe, effective and durable in patients with urge incontinence refractory to conservative treatment.
保守治疗很少能使急迫性尿失禁和膀胱过度活动症患者获得持久治愈。器械治疗和手术治疗往往有显著的副作用且效果欠佳。我们开发了一种骶神经调节技术，通过对S3骶神经进行慢性单侧电刺激来抑制排尿反射，为对保守治疗无效的患者提供有效的非破坏性替代疗法。
85例患者中，45例对临时电极测试有反应者接受了与脉冲发生器相连的永久性S3骶神经电极植入。通过尿动力学研究以及记录护垫使用情况、尿失禁发作次数、排尿频率和排尿量的排尿/失禁日记来评估治疗效果。部分成功和治愈分别定义为护垫使用量和/或尿失禁发作次数改善50%至90%以及超过90%。
45例患者中，18例（40%）在平均47.1个月的随访后治愈，9例（20%）取得部分成功。植入后6个月，每日使用护垫的中位数和尿失禁发作的中位数分别从5.4降至1.2（p = 0.0001）和7.1降至1.3（p = 0.0001）。随后这些结果在5年中几乎保持不变。44例患者中有19例（43%）膀胱过度活动消失。再次干预率为37.7%，未发生永久性损伤或神经损害。
骶神经调节对于保守治疗无效的急迫性尿失禁患者安全、有效且持久。
