Martín Braun Peter, Arancibia Fernández Mario Ignacio, Martínez Portillo Francisco J, Seif Christoph, Sotelino Crespo Antonio, Sugimoto Shuji, de Dios Montoto Emilia, Alken Peter, Jünemann Klaus-Peter
Departamento de Urología, Hospital Universitario de Kiel, Universidad de Kiel, Alemania.
Arch Esp Urol. 2003 Jun;56(5):497-501.
Up to 50% of patients with bladder dysfunctions undergoing sacral neuromodulation treatment are non-responders. The most common treatment method today is the implantable neuromodulation system described by Tanagho and Schmidt; which allows unilateral sacral nerve stimulation. Our aim was to increase the number of responders and to improve the general efficiency of chronic sacral neuromodulation; therefore we have developed the bilateral electrode implantation by minimally invasive laminectomy.
PNE-tests were carried out to assess which patients were likely to be good responders. Thirty patients (16 with detrusor instability, 14 with hypocontractile detrusors) were subjected to minimally invasive laminectomy and received implants of bilateral electrodes.
In those patients with a hyopcontractile detrusor, the level of residual urine of initially 350 ml was reduced to 58 ml, and the maximum detrusor pressure during micturition increased from initially 12 cMH2O to 34 cmH2O. In the other patient group with detrusor instability, the average number of incontinence incidences could be reduced from initially 7.2 to 1 per day, while the bladder capacity rose from 198 ml to 348 ml. The modulation effect did not show any signs of deteriorating in any of the patients. The follow-up period was 28 months on average.
Clinical experience has shown that optimal neuromodulation in patients with bladder dysfunction can be achieved by this new approach involving bilateral electrode implantation. Moreover, the laminectomy implantation method guarantees a minimum of invasive trauma and enables optimal placement and fixation of the electrode.
接受骶神经调节治疗的膀胱功能障碍患者中，高达50%的患者无反应。目前最常见的治疗方法是Tanagho和Schmidt描述的可植入神经调节系统，该系统允许单侧骶神经刺激。我们的目标是增加有反应者的数量并提高慢性骶神经调节的总体效率，因此我们通过微创椎板切除术开发了双侧电极植入术。
进行阴部神经电刺激（PNE）测试以评估哪些患者可能是良好的反应者。30例患者（16例逼尿肌不稳定，14例逼尿肌收缩力减弱）接受了微创椎板切除术并植入了双侧电极。
在逼尿肌收缩力减弱的患者中，初始残余尿量350 ml降至58 ml，排尿时最大逼尿肌压力从初始的12 cmH₂O增加到34 cmH₂O。在另一组逼尿肌不稳定的患者中，尿失禁发生率的平均数可从初始的每天7.2次减少到1次，而膀胱容量从198 ml增加到348 ml。在任何患者中，调节效果均未显示出恶化的迹象。平均随访期为28个月。
临床经验表明，通过这种涉及双侧电极植入的新方法，可以在膀胱功能障碍患者中实现最佳神经调节。此外，椎板切除术植入方法保证了最小的创伤，并能实现电极的最佳放置和固定。
