Van Voskuilen Anco C, Oerlemans Dennis J A J, Weil Ernest H J, van den Hombergh Ubi, van Kerrebroeck Philip E V A
Department of Urology, Academisch Ziekenhuis Maastricht, Maastricht, the Netherlands and Medtronic Europe S.A., Tolochenaz, Switzerland.
BJU Int. 2007 Jan;99(1):107-10. doi: 10.1111/j.1464-410X.2006.06508.x. Epub 2006 Sep 6.
To describe patient selection for sacral neuromodulation, also known as Interstim therapy, and the results of tined-lead implantation in the medium term.
In all, 49 patients, 39 with refractory overactive bladder symptoms and 10 with urinary retention, were implanted with the tined lead under local anaesthesia. The mean (sd) test period was 12.4 (5.8) days. Patients were implanted when they had a > or = 50% improvement in voiding diary variables during the test period. The mean follow-up for implanted patients was 15.5 (7.9) months. Changes in voiding variables were compared using a t-test.
Ten patients had a one-stage and 39 a two-stage implant; of the latter group, 31 (80%) had a positive response and eight (21%) did not. In all, 31 patients were included in the follow-up. At the last follow-up, 28 (90%) patients had a >50% improvement in diary variables and three (10%) did not. In 21 patients with urgency symptoms the mean (sd) number of voids decreased from 11.7 (8.9)/day at baseline to 7.3 (3.4)/day (P = 0.1); the voided volume increased from 160.2 (70.7) mL to 231.1 (119.5) mL (P = 0.001); and the number of leakages decreased from 9.5 (8.7) to 3.3 (2.2)/day (P = 0.17). In the 10 patients with retention, the number of catheterizations decreased from 5.44 (1.6)/day with a volume of 297.6 (76.8) mL, to 1.2 (1.7)/day and 111.6 (158.1) mL; the mean number of voids increased from 3.7 (3.8)/day with a volume of 123.3 (141.7) mL, to 4.2 (2.4)/day and 248.3 (146.0)mL. There were no significant differences in the variables in the patients with retention. Seven patients had an adverse event. There was one incomplete electrode migration that was treated conservatively.
This new minimally invasive approach gives positive results in the medium term. Two-stage testing with the tined lead seems more reliable than the classic percutaneous nerve evaluation. The lead anchoring method seems sufficient for fixing the electrode in the medium term.
描述骶神经调节（也称为Interstim疗法）的患者选择标准以及中期有倒刺导线植入的结果。
总共49例患者，其中39例有难治性膀胱过度活动症状，10例有尿潴留，在局部麻醉下植入倒刺导线。平均（标准差）测试期为12.4（5.8）天。当患者在测试期内排尿日记变量改善≥50%时进行植入。植入患者的平均随访时间为15.5（7.9）个月。使用t检验比较排尿变量的变化。
10例患者进行了一期植入，39例进行了二期植入；在后一组中，31例（80%）有阳性反应，8例（21%）无阳性反应。总共31例患者纳入随访。在最后一次随访时，28例（90%）患者日记变量改善超过50%，3例（10%）未超过。21例有尿急症状的患者，平均（标准差）排尿次数从基线时的11.7（8.9）次/天降至7.3（3.4）次/天（P = 0.1）；排尿量从160.2（70.7）mL增至231.1（119.5）mL（P = 0.001）；漏尿次数从9.5（8.7）次/天降至3.3（2.2）次/天（P = 0.17）。10例有尿潴留的患者，导尿次数从5.44（1.6）次/天、尿量297.6（76.8）mL，降至1.2（1.7）次/天和111.6（158.1）mL；平均排尿次数从3.7（3.8）次/天、尿量123.3（141.7）mL，增至4.2（2.4）次/天和248.3（146.0）mL。尿潴留患者的这些变量无显著差异。7例患者发生不良事件。有1例电极不完全移位，采用保守治疗。
这种新的微创方法在中期取得了阳性结果。使用倒刺导线进行两阶段测试似乎比经典的经皮神经评估更可靠。导线固定方法在中期似乎足以固定电极。
