Groenendijk P M, Heesakkers J P F A, Lycklama A Nijeholt A A B
Department of Urology, Leiden University Medical Center, Leiden and Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
J Urol. 2007 Aug;178(2):568-72; discussion 572. doi: 10.1016/j.juro.2007.03.120. Epub 2007 Jun 14.
Urodynamic parameters that predict the outcome of sacral nerve stimulation are difficult to define. We studied the predictive value of urethral instability and other urodynamic parameters on the efficacy of sacral nerve stimulation.
Patients with refractory voiding disorders were implanted with a neurostimulator after responding with more than 50% improvement in main symptoms after percutaneous nerve evaluation. Filling cystometry was performed with 3 urethral sensors and 1 bladder sensor at baseline and 6 months after implantation. Urethral pressure variations more than 15 cm H(2)O were considered pathological and defined as urethral instability. Clinical efficacy was evaluated by voiding diary data and defined as successful when greater than 50% improvement was observed.
A total of 19 female patients enrolled in the study. At baseline detrusor overactivity was observed in 9 patients, while 18 showed urethral instability. Sacral nerve stimulation therapy was successful in 13 patients (68%). The number of pads used per day and the severity of leakage decreased significantly. Of the 13 successfully treated patients 12 showed urethral instability at baseline. Detrusor overactivity was present in 4 successfully treated patients. Urethral instability disappeared in 7 of the 13 successfully treated patients and detrusor overactivity disappeared in only 1 of these patients.
In this study urethral instability appeared to be a valuable urodynamic parameter for predicting the outcome of sacral nerve stimulation.
预测骶神经刺激结果的尿动力学参数难以确定。我们研究了尿道不稳定及其他尿动力学参数对骶神经刺激疗效的预测价值。
难治性排尿障碍患者在经皮神经评估后主要症状改善超过50%时植入神经刺激器。在基线及植入后6个月时，使用3个尿道传感器和1个膀胱传感器进行膀胱充盈测压。尿道压力变化超过15 cm H₂O被视为病理性，定义为尿道不稳定。通过排尿日记数据评估临床疗效，当观察到改善超过50%时定义为成功。
共有19名女性患者纳入研究。基线时，9名患者观察到逼尿肌过度活动，18名患者表现为尿道不稳定。骶神经刺激治疗13名患者成功（68%）。每天使用的尿垫数量及漏尿严重程度显著降低。在13名成功治疗的患者中，12名在基线时表现为尿道不稳定。4名成功治疗的患者存在逼尿肌过度活动。13名成功治疗的患者中，7名尿道不稳定消失，这些患者中仅1名逼尿肌过度活动消失。
在本研究中，尿道不稳定似乎是预测骶神经刺激结果的一个有价值的尿动力学参数。
