Sønksen Jens, Ohl Dana A, Bonde Birthe, Laessøe Line, McGuire Edward J
Department of Urology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
J Urol. 2007 Nov;178(5):2025-8. doi: 10.1016/j.juro.2007.07.012. Epub 2007 Sep 17.
We defined basic guidelines for transcutaneous mechanical nerve stimulation in modifying pelvic floor responses in women and determined the efficacy of transcutaneous mechanical nerve stimulation in treating stress urinary incontinence.
Perineal and clitoral transcutaneous mechanical nerve stimulation was performed in healthy volunteers while measuring changes in peak urethral pressure to determine optimal vibration amplitude and site of stimulation. Perineal transcutaneous mechanical nerve stimulation was then performed weekly for 6 weeks in a cohort of women with stress urinary incontinence (33). Reduction in incontinence episodes and pad use on voiding diary were compared from baseline to 6 weeks. Global efficacy was determined at 6 weeks and 3 months after the completion of the program.
In healthy subjects a vibration amplitude of 2.0 mm resulted in the highest urethral pressure increase. Although the increase with perineal transcutaneous mechanical nerve stimulation was lower than that seen with clitoral stimulation (80 vs 115 cm H(2)O), perineal transcutaneous mechanical nerve stimulation was more acceptable to the patient and resulted in a better subjective response. Urethral pressure increases with transcutaneous mechanical nerve stimulation at either site were greater than with voluntary contraction (60 cm H(2)O). After 6 weeks of transcutaneous mechanical nerve stimulation in the subjects with stress urinary incontinence, there was a significant reduction in daily incontinence episodes (2.6 +/- 1.1 vs 0.5 +/- 1.1, paired t test p <0.001) and pad use (3.5 +/- 0.9 vs 0.6 +/- 1.3, paired t test p <0.001). At 6 weeks the cure rate (no incontinence episodes) was 73%, with durability through 3 months with 67% still reporting persistent resolution.
Perineal transcutaneous mechanical nerve stimulation has promise as a noninvasive and well tolerated method of treating stress urinary incontinence.
我们定义了经皮机械神经刺激调节女性盆底反应的基本指南，并确定了经皮机械神经刺激治疗压力性尿失禁的疗效。
对健康志愿者进行会阴和阴蒂经皮机械神经刺激，同时测量尿道峰值压力的变化，以确定最佳振动幅度和刺激部位。然后，对一组压力性尿失禁女性患者（33例）每周进行1次会阴经皮机械神经刺激，共6周。比较从基线到6周期间排尿日记中尿失禁发作次数和护垫使用量的减少情况。在该项目完成后6周和3个月时确定总体疗效。
在健康受试者中，2.0毫米的振动幅度导致尿道压力升高幅度最大。尽管会阴经皮机械神经刺激引起的压力升高低于阴蒂刺激（80 vs 115厘米水柱），但会阴经皮机械神经刺激更易被患者接受，且主观反应更好。两个部位的经皮机械神经刺激引起的尿道压力升高均大于自主收缩（60厘米水柱）。对压力性尿失禁患者进行6周经皮机械神经刺激后，每日尿失禁发作次数显著减少（2.6±1.1 vs 0.5±1.1，配对t检验p<0.001），护垫使用量也显著减少（3.5±0.9 vs 0.6±1.3，配对t检验p<0.001）。6周时治愈率（无尿失禁发作）为73%，3个月时仍有67%的患者报告持续缓解。
会阴经皮机械神经刺激有望成为一种治疗压力性尿失禁的非侵入性且耐受性良好的方法。
