Chartier-Kastler E J, Ruud Bosch J L, Perrigot M, Chancellor M B, Richard F, Denys P
Departments of Urology and Neurologic Rehabilitation, Pitié-Salpétrière Hospital, University Pierre et Marie Curie (Paris VI), Paris, France.
J Urol. 2000 Nov;164(5):1476-80.
We assess clinical and urodynamic results of sacral nerve stimulation for patients with neurogenic (spinal cord diseases) urge incontinence and detrusor hyperreflexia resistant to parasympatholytic drugs.
Since 1992, 9 women with a mean age of 42.6 years (range 26 to 53) were treated for refractory neurogenic urge incontinence with sacral nerve stimulation. Neurological spinal diseases included viral and vascular myelitis in 1 patient each, multiple sclerosis in 5 and traumatic spinal cord injury in 2. Mean time since neurological diagnosis was 12 years. All patients had incontinence with chronic pad use related to detrusor hyperreflexia. Intermittent self-catheterization for external detrusor-sphincter dyssynergia was used by 5 patients. Social life was impaired and these patients were candidates for bladder augmentation. A sacral (S3) lead was surgically implanted and connected to a subcutaneous neurostimulator after a positive test stimulation trial.
Mean followup was 43.6 months (range 7 to 72). All patients had clinically significant improvement of incontinence, and 5 were completely dry. Average number of voids per day decreased from 16.1 to 8.2. Urodynamic parameters at 6 months after implant improved significantly from baseline, including maximum bladder capacity from 244 to 377 ml. and volume at first uninhibited contraction from 214 to 340 ml. Maximum detrusor pressure at first uninhibited contraction increased in 3, stabilized in 2 and decreased in 4 patients. Urodynamic results returned to baseline when stimulation was inactivated. All patients subjectively reported improved visual analog scale results by at least 75% at last followup.
Sacral nerve stimulation can be used as a reversible treatment option for refractory urge incontinence related to detrusor hyperreflexia in select patients with spinal lesions.
我们评估骶神经刺激对患有神经源性（脊髓疾病）急迫性尿失禁且对副交感神经阻滞剂耐药的逼尿肌反射亢进患者的临床及尿动力学结果。
自1992年起，9名平均年龄42.6岁（范围26至53岁）的女性接受了骶神经刺激治疗难治性神经源性急迫性尿失禁。神经脊髓疾病包括1例病毒性和1例血管性脊髓炎、5例多发性硬化症和2例创伤性脊髓损伤。自神经学诊断后的平均时间为12年。所有患者因逼尿肌反射亢进长期使用尿垫而出现尿失禁。5例患者因外括约肌协同失调采用间歇性自我导尿。社交生活受到影响，这些患者均为膀胱扩大术的候选者。在试验性刺激测试呈阳性后，通过手术植入骶（S3）电极并连接至皮下神经刺激器。
平均随访43.6个月（范围7至72个月）。所有患者尿失禁均有显著临床改善，5例完全干爽。每日平均排尿次数从16.1次降至8.2次。植入后6个月时的尿动力学参数较基线有显著改善，包括最大膀胱容量从244毫升增至377毫升，首次无抑制性收缩时的容量从214毫升增至340毫升。首次无抑制性收缩时的最大逼尿肌压力，3例患者升高，2例稳定，4例降低。刺激停止后，尿动力学结果恢复至基线。所有患者在最后一次随访时主观报告视觉模拟量表结果至少改善了75%。
对于部分患有脊髓病变且与逼尿肌反射亢进相关的难治性急迫性尿失禁患者，骶神经刺激可作为一种可逆的治疗选择。
