Elhilali Mostafa M, Khaled Sabri M, Kashiwabara Takeshi, Elzayat Ehab, Corcos Jacques
Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
Urology. 2005 Jun;65(6):1114-7. doi: 10.1016/j.urology.2004.12.016.
To perform a retrospective analysis of the long-term results of our experience with neuromodulation. Our center has been involved in the early studies leading to approval of the NeuroStim system of neuromodulation for the treatment of patients presenting with refractory lower urinary symptoms of urgency/frequency with or without incontinence and chronic urinary retention.
A total of 52 patients have undergone implantation at our center since 1990 using very rigid criteria, including temporary percutaneous nerve evaluation for up to 7 days and a requirement of 50% improvement before consideration for implantation. Patients were followed up closely and a telephone questionnaire was conducted for those patients not seen in the previous 6 months. Of the 52 patients, 11 were not available for evaluation. Of the 41 remaining patients, 22 had urgency/frequency syndrome, 6 had urgency incontinence, 9 had urinary retention, and 4 had interstitial cystitis with intractable pelvic pain.
Of the 41 patients, 5 required explantation. These 5 patients were offered reimplantation but declined. Of the 22 patients in the urgency/frequency group, 10 (45%) had persistent improvement. In the urgency incontinence group, 3 of the 6 patients required explantation, and 1 (17%) reported improvement in the frequency of incontinence episodes. Of the 9 patients in the chronic urinary retention group, 7 (78%) had improvement.
The long-term (up to 13 years) results of neuromodulation in patients presenting with urgency/frequency with and without urge incontinence and urinary retention were reviewed. The long-term results in the first two groups were not maintained over time. The patients with chronic urinary retention, although a small sample, fared better.
对我们在神经调节方面的长期经验结果进行回顾性分析。我们中心参与了早期研究，这些研究促成了神经刺激系统用于治疗伴有难治性下尿路尿急/尿频症状（伴或不伴有尿失禁）以及慢性尿潴留患者的获批。
自1990年以来，共有52例患者在我们中心接受了植入手术，采用了非常严格的标准，包括长达7天的临时经皮神经评估以及在考虑植入前需有50%的改善。对患者进行密切随访，并对过去6个月未就诊的患者进行电话问卷调查。52例患者中，11例无法进行评估。其余41例患者中，22例患有尿急/尿频综合征，6例患有急迫性尿失禁，9例患有尿潴留，4例患有间质性膀胱炎伴顽固性盆腔疼痛。
41例患者中，5例需要取出植入物。这5例患者被提供了重新植入的机会，但拒绝了。在尿急/尿频组的22例患者中，10例（45%）持续改善。在急迫性尿失禁组的6例患者中，3例需要取出植入物，1例（17%）报告尿失禁发作频率有所改善。在慢性尿潴留组的9例患者中，7例（78%）有改善。
回顾了神经调节对伴有和不伴有急迫性尿失禁及尿潴留的尿急/尿频患者的长期（长达13年）结果。前两组的长期结果未随时间维持稳定。慢性尿潴留患者虽然样本量小，但情况较好。
