Decter R M, Snyder P, Rosvanis T K
Department of Surgery, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey.
J Urol. 1992 Aug;148(2 Pt 2):651-3; discussion 654. doi: 10.1016/s0022-5347(17)36682-x.
Transurethral electrical bladder stimulation to rehabilitate the neurogenic bladder initially proposed by Katona has been promoted in the United States by Kaplan and Richards since the mid 1980s. Encouraged by their results, 2 1/2 years ago we instituted a program patterned on their experience. Since January 1989 we performed transurethral electrical bladder stimulation in 21 patients ranging in age from 4 months to 26 years. The cause of the neurogenic bladder was myelomeningocele in 16 patients, lipomeningocele in 4 and an incomplete spinal cord injury in 1. The stimulation was performed using equipment supplied by Kaplan and Richards, and the stimulation protocol followed their recommendations. The treatments were delivered in daily sessions of 90 minutes with about 20 sessions in a series. Of the patients 11 have undergone 1,6 have finished 2 and 4 have completed 3 series of stimulation. The ultimate objective of the program is to achieve volitional voiding. To reach that goal the stimulation must engender a bladder contraction that must then be perceived and ultimately controlled. Of our patients 20 (95%) achieved bladder contractions during stimulation, including 12 (60%) who had either a definite (7) or probable (5) sense of these contractions. To date, only 1 patient has started the biofeedback program to attempt to modify detrusor activity and he is presently wet on clean intermittent catheterization. Parents of 5 other children report minor positive changes in the child's perception of the bladder activity. Three patients noticed an improvement in the bowel program, although the effect only lasted during the month of stimulation in 1. Cystometrograms were performed before each series of treatments. Of the 10 patients with serial studies 2 had significant increases in bladder capacity and 3 demonstrated a clinically significant decrease in the end filling pressures. We have seen limited encouraging results from transurethral electrical bladder stimulation. This is a time-consuming, labor intensive program, and the parents and patients need to be informed of the actual potential for dramatic improvements.
经尿道膀胱电刺激用于神经源性膀胱康复，最初由卡托纳提出，自20世纪80年代中期以来，在美国由卡普兰和理查兹推广。受他们研究结果的鼓舞，两年半前我们依据他们的经验开展了一个项目。自1989年1月以来，我们对21例年龄从4个月到26岁的患者进行了经尿道膀胱电刺激。神经源性膀胱的病因，16例为脊髓脊膜膨出，4例为脂肪脊髓脊膜膨出，1例为不完全性脊髓损伤。刺激使用卡普兰和理查兹提供的设备，并遵循他们推荐的刺激方案。治疗每天进行90分钟，一个疗程约20次。在这些患者中，11例接受了1个疗程，6例完成了2个疗程，4例完成了3个疗程的刺激。该项目的最终目标是实现自主排尿。为达到这一目标，刺激必须引发膀胱收缩，然后患者必须感知到并最终加以控制。我们的患者中，20例（95%）在刺激过程中实现了膀胱收缩，其中12例（60%）对这些收缩有明确（7例）或可能（5例）的感觉。迄今为止，只有1例患者开始了生物反馈项目以试图调节逼尿肌活动，他目前在清洁间歇性导尿时仍会尿床。其他5名儿童的家长报告说孩子对膀胱活动的感知有轻微积极变化。3例患者注意到肠道功能有所改善，不过其中1例的效果仅在刺激期间持续了一个月。在每个疗程治疗前都进行了膀胱测压。在10例接受系列研究的患者中，2例膀胱容量显著增加，3例终末充盈压在临床上有显著降低。我们从经尿道膀胱电刺激中看到了有限的鼓舞人心的结果。这是一个耗时、劳动强度大的项目，需要让家长和患者了解实际可能取得显著改善的潜力。
