骶神经刺激治疗尿潴留的疗效：植入后18个月的结果

Efficacy of sacral nerve stimulation for urinary retention: results 18 months after implantation.

作者信息

Jonas U, Fowler C J, Chancellor M B, Elhilali M M, Fall M, Gajewski J B, Grünewald V, Hassouna M M, Hombergh U, Janknegt R, van Kerrebroeck P E, Lylcklama a Nijeholt A A, Siegel S W, Schmidt R A

机构信息

Medizinische Hochschule Hannover, Hannover, Germany.

出版信息

J Urol. 2001 Jan;165(1):15-9. doi: 10.1097/00005392-200101000-00004.

DOI:10.1097/00005392-200101000-00004

PMID:11125353

Abstract

PURPOSE

We investigate the efficacy of sacral neurostimulation in patients with idiopathic urinary retention in a prospective, randomized multicenter trial.

MATERIALS AND METHODS

A total of 177 patients with urinary retention refractory to standard therapy were enrolled in the study. Greater than 50% improvement in baseline voiding symptoms during a 3 to 7-day percutaneous test stimulation qualified a patient for surgical implantation of an InterStim parallel system. Of the patients who qualified for implantation 37 were randomly assigned to a treatment and 31 to a control group. Patients in the treatment group underwent early surgical implantation of the sacral nerve stimulation system, while implantation was delayed in the control group for 6 months. Followup evaluations, including voiding diary analysis and temporary deactivation of the stimulator at 6 months, were conducted at 1, 3, 6, 12 and 18 months after implantation in the treatment group, and after 3 and 6 months in the control group.

RESULTS

Compared to the control group, patients implanted with the InterStim system had statistically and clinically significant reductions in the catheter volume per catheterization (p <0.0001). Of the patients treated with implants 69% eliminated catheterization at 6 months and an additional 14% had a 50% or greater reduction in catheter volume per catheterization. Therefore, successful results were achieved in 83% of the implant group with retention compared to 9% of the control group at 6 months. Temporary inactivation of sacral nerve stimulation therapy resulted in a significant increase in residual volumes (p <0.0001) but effectiveness of sacral nerve stimulation was sustained through 18 months after implant.

CONCLUSIONS

Results of this prospective, randomized clinical study demonstrate that sacral nerve stimulation is effective for restoring voiding in patients with retention who are refractory to other forms of treatment.

摘要

目的

我们在一项前瞻性、随机多中心试验中研究骶神经刺激对特发性尿潴留患者的疗效。

材料与方法

共有177例对标准治疗无效的尿潴留患者纳入本研究。在3至7天的经皮试验刺激期间，基线排尿症状改善超过50%的患者有资格接受InterStim平行系统的手术植入。在符合植入条件的患者中，37例被随机分配至治疗组，31例被分配至对照组。治疗组患者接受骶神经刺激系统的早期手术植入，而对照组的植入延迟6个月。在治疗组植入后1、3、6、12和18个月，以及对照组3和6个月后进行随访评估，包括排尿日记分析和6个月时刺激器的临时停用。

结果

与对照组相比，植入InterStim系统的患者每次导尿的尿量在统计学和临床上均有显著减少（p<0.0001）。在接受植入治疗的患者中，69%在6个月时不再需要导尿，另有14%每次导尿的尿量减少了50%或更多。因此，植入组中83%的尿潴留患者取得了成功结果，而对照组在6个月时为9%。骶神经刺激治疗的临时停用导致残余尿量显著增加（p<0.0001），但骶神经刺激的有效性在植入后持续了18个月。