Starkman Jonathan S, Wolter Christopher E, Scarpero Harriette M, Milam Douglas F, Dmochowski Roger R
Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, Tennessee 37232-2765, USA.
Neurourol Urodyn. 2007;26(1):29-35; discussion 36. doi: 10.1002/nau.20360.
We sought to explore our patient outcomes utilizing sacral neuromodulation in the management of refractory urinary urge incontinence following urogynecological surgical procedures.
A total of 25 women with urinary urge incontinence following urogynecological surgery were selected for SNS therapy and retrospectively analyzed. All patients completed a comprehensive urological evaluation. Clinical data was recorded to determine outcomes and identify parameters that would be predictive of response to neuromodulation. Outcomes were determined via subjective patient questionnaire and graded as follows: significant response (> or =80% improvement), moderate response (> or =50% and <80% improvement), and poor response (<50% response).
Nineteen patients had a previous pubovaginal sling (10 with concomitant pelvic prolapse repair), 3 a previous retropubic suspension, and 3 a transperitoneal vesicovaginal fistula repair. Urethrolysis was performed in 4 patients to alleviate bladder outlet obstruction prior to sacral neuromodulation. Mean patient age was 59.8 years and length of follow-up was 7.2 months. Twenty-two women (88%) had the IPG placed during a Stage 2 procedure. Twenty patients maintained at least a 50% improvement in clinical symptoms at last follow-up and 6 patients were continent. Overall, the number of pads/day improved from 4.2 to 1.1 (P < 0.001). There were no significant differences in response to neuromodulation based upon age, duration of symptoms, type of surgery, or urodynamic parameters.
Sacral neuromodulation appears to be an effective therapy in patients with refractory urge incontinence following urogynecological surgery. Larger prospective studies with longer follow-up are needed to assess the durability of this therapeutic modality.
我们试图探讨在妇科泌尿手术后难治性尿急失禁的管理中使用骶神经调节的患者结局。
共选择25例妇科泌尿手术后尿急失禁的女性进行骶神经调节治疗（SNS），并进行回顾性分析。所有患者均完成了全面的泌尿外科评估。记录临床数据以确定结局并识别可预测神经调节反应的参数。通过患者主观问卷确定结局，并分级如下：显著反应（改善≥80%）、中度反应（改善≥50%且<80%）和差反应（反应<50%）。
19例患者曾接受耻骨后阴道吊带术（10例同时进行盆腔脱垂修复），3例曾接受耻骨后悬吊术，3例曾接受经腹膀胱阴道瘘修补术。4例患者在骶神经调节前进行了尿道松解术以缓解膀胱出口梗阻。患者平均年龄为59.8岁，随访时间为7.2个月。22名女性（88%）在二期手术中植入了植入式脉冲发生器（IPG）。20例患者在最后一次随访时临床症状至少改善了50%，6例患者实现了控尿。总体而言，每天使用的尿垫数量从4.2片减少至1.1片（P<0.001）。基于年龄、症状持续时间、手术类型或尿动力学参数，神经调节反应无显著差异。
骶神经调节似乎是妇科泌尿手术后难治性尿急失禁患者的一种有效治疗方法。需要进行更大规模、随访时间更长的前瞻性研究来评估这种治疗方式的持久性。
