Braun P M, Böhler G
Urologische Universitätsklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 7, 24105 Kiel.
Urologe A. 2006 Jul;45(7):835-40. doi: 10.1007/s00120-006-1085-8.
Currently, sacral nerve modulation (SNM) is an effective treatment for overactive bladder symptoms which are refractory to anticholinergic or muscarinergic treatment. However, SNM requires the implantation of stimulation electrodes at the sacral nerves and a subcutaneous impulse generator. The SNM procedure can be divided into three phases: the acute phase comprising the implantation of the test stimulation electrodes, the subchronic stimulation phase over a period of 7-14 days during which neurostimulation takes place by means of an external impulse generator, and finally chronic SNM after implantation of the final impulse generator. In 1981 the SNM technique for treatment of bladder dysfunctions was first developed by Tanagho and Schmidt and has since been refined, while the range of indications has been extended continuously. It has been shown that patients with neurogenic bladder dysfunctions are able to gain the greatest benefit from SNM. The long-term results of SNM are very encouraging so far. In addition, a highly innovative and promising technique is the implantation of a miniaturized impulse generator with integrated stimulation electrode at the n. pudendus. However, the outcome of these trials has not fully been capable of living up to the expectations so far.
目前，骶神经调节（SNM）是治疗抗胆碱能或毒蕈碱能治疗无效的膀胱过度活动症症状的一种有效方法。然而，SNM需要在骶神经处植入刺激电极和一个皮下脉冲发生器。SNM手术可分为三个阶段：急性期包括植入测试刺激电极；亚慢性刺激阶段为期7至14天，在此期间通过外部脉冲发生器进行神经刺激；最后是在植入最终脉冲发生器后的慢性SNM阶段。1981年，Tanagho和Schmidt首次开发了用于治疗膀胱功能障碍的SNM技术，此后该技术不断完善，适应症范围也不断扩大。研究表明，神经源性膀胱功能障碍患者能从SNM中获益最大。迄今为止，SNM的长期效果非常令人鼓舞。此外，一种极具创新性和前景的技术是在阴部神经处植入带有集成刺激电极的小型化脉冲发生器。然而，到目前为止，这些试验的结果尚未完全达到预期。
