经皮电神经刺激治疗难治性非神经性膀胱括约肌功能障碍患儿的一项初步研究。
Percutaneous electrical nerve stimulation in children with therapy resistant nonneuropathic bladder sphincter dysfunction: a pilot study.
作者信息
Hoebeke P, Renson C, Petillon L, Vande Walle J, De Paepe H
机构信息
Paediatric Uro Nephrologic Centre, Department of Rehabilitation Sciences and Physical Therapy, Gent University Hospital, Belgium.
出版信息
J Urol. 2002 Dec;168(6):2605-7; discussion 2607-8. doi: 10.1016/S0022-5347(05)64227-9.
PURPOSE
We evaluated the effect of percutaneous electrical nerve stimulation on voiding dysfunction in a group of children with therapy resistant, nonneuropathic bladder sphincter dysfunction.
MATERIALS AND METHODS
In a prospective study 17 boys and 15 girls with mean age of 11.7 years underwent percutaneous electrical nerve stimulation after the failure of more than 2 years of urological and/or pharmacotherapy. The device for percutaneous electrical nerve stimulation consists of an interface cable, a surface electrode, a percutaneous needle and a portable stimulator. The needle is inserted at the tibial nerve level and a portable stimulator provided pulsations at a frequency of 20 Hz. for 30 minutes once weekly. Every 6 weeks the children were evaluated. Evaluation parameters were urgency, daytime incontinence, voiding frequency, the uroflowmetry curve and bladder capacity. When favorable results were observed after 6 sessions, therapy was continued for another 12 sessions. In 24 children anticholinergics started before stimulation that had only a partial effect were continued during stimulation.
RESULTS
In 7 of the 28 children with urgency before therapy it disappeared after therapy and in 10 it improved. Of the 23 children with daytime incontinence before treatment 4 became dry after stimulation and in 12 incontinence decreased. Of the 19 patients who reported disturbed voiding frequency of less than 4 or more than 8 voids daily 16 achieved a normal frequency of 4 to 6 voids daily. In 21 children an abnormal uroflowmetry curve was observed before stimulation, while in 9 the flow curve was normal after therapy. Mean bladder capacity increased significantly from 185.16 to 279.19 ml.
CONCLUSIONS
Percutaneous electrical nerve stimulation has a significant effect on voiding frequency, the uroflowmetry curve and bladder capacity in children with nonneurogenic bladder sphincter dysfunction
目的
我们评估了经皮电神经刺激对一组患有治疗抵抗性、非神经性膀胱括约肌功能障碍儿童排尿功能障碍的影响。
材料与方法
在一项前瞻性研究中，17名男孩和15名女孩，平均年龄11.7岁，在经过超过2年的泌尿外科和/或药物治疗失败后，接受了经皮电神经刺激治疗。经皮电神经刺激装置由一根接口电缆、一个表面电极、一根经皮针和一个便携式刺激器组成。将针插入胫神经水平，便携式刺激器以20赫兹的频率提供脉冲，每周一次，每次30分钟。每6周对儿童进行评估。评估参数包括尿急、日间尿失禁、排尿频率、尿流率曲线和膀胱容量。当在6次治疗后观察到良好效果时，治疗再持续12次。在24名儿童中，刺激前开始使用的抗胆碱能药物仅部分有效，在刺激期间继续使用。
结果
在治疗前有尿急的28名儿童中，7名在治疗后尿急消失，10名有所改善。在治疗前有日间尿失禁的23名儿童中，4名在刺激后不再尿失禁，12名尿失禁情况减轻。在报告每日排尿频率紊乱少于4次或多于8次的19名患者中，16名实现了每日4至6次的正常排尿频率。21名儿童在刺激前观察到尿流率曲线异常，而9名儿童在治疗后尿流曲线正常。平均膀胱容量从185.16毫升显著增加到279.19毫升。
结论
经皮电神经刺激对非神经源性膀胱括约肌功能障碍儿童的排尿频率、尿流率曲线和膀胱容量有显著影响。
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