Groenendijk Pieter M, Lycklama à Nyeholt August A B, Heesakkers John P F A, van Kerrebroeck Philip E V, Hassouna Magdy M, Gajewski Jerzy B, Cappellano Francesco, Siegel Steven W, Fall Magnus, Dijkema Hero E, Jonas Udo, van den Hombergh Ubi
Leiden University Medical Centre, Leiden, The Netherlands.
BJU Int. 2008 Feb;101(3):325-9. doi: 10.1111/j.1464-410X.2007.07258.x. Epub 2007 Dec 5.
To evaluate the urodynamic data before and 6 months after implantation of sacral neuromodulation (SNM, an established treatment for voiding dysfunction, including refractory urge urinary incontinence, UI) and to assess the correlation between the urodynamic data and clinical efficacy in patients with UI.
In all, 111 patients with a >50% reduction in UI symptoms during a percutaneous nerve evaluation test qualified for surgical implantation of SNM. Patients were categorized in two subgroups, i.e. those with UI with or without confirmed detrusor overactivity (DO) at baseline. At the 6-month follow-up all patients had a second urodynamic investigation, with the stimulator switched on.
At baseline, there was urodynamically confirmed DO in 67 patients, while 44 showed no DO. A review of filling cystometry variables showed a statistically significant improvement in bladder volumes at first sensation of filling (FSF) and at maximum fill volume (MFV) before voiding for both UI subgroups, compared with baseline. In 51% of the patients with UI and DO at baseline, the DO resolved during the follow-up. However, those patients were no more clinically successful than those who still had DO (P = 0.73). At the 6-month follow-up, 55 of 84 implanted patients showed clinical benefit, having a >or=50% improvement in primary voiding diary variables. Patients with UI but no DO had a higher rate of clinical success (73%) than patients with UI and DO (61%), but the difference was not statistically significant.
These urodynamic results show a statistically significant improvement in FSF and MFV in patients with UI with or with no DO after SNM. Although there was a urodynamic and clinical improvement in both groups, patients with UI but no DO are at least as successful as patients with UI and DO. Therefore in patients with UI, DO should not be a prerequisite selection criterion for using SNM.
评估骶神经调节（SNM，一种用于治疗排尿功能障碍，包括难治性急迫性尿失禁的既定疗法）植入术前及术后6个月的尿动力学数据，并评估尿动力学数据与尿失禁患者临床疗效之间的相关性。
共有111例在经皮神经评估测试期间尿失禁症状减轻超过50%的患者符合SNM手术植入条件。患者被分为两个亚组，即基线时伴有或不伴有确诊逼尿肌过度活动（DO）的尿失禁患者。在6个月随访时，所有患者均进行了第二次尿动力学检查，且刺激器处于开启状态。
基线时，67例患者经尿动力学证实存在DO，而44例未显示DO。对充盈性膀胱测压变量的回顾显示，与基线相比，两个尿失禁亚组在排尿前首次有充盈感觉（FSF）时的膀胱容量和最大充盈容量（MFV）均有统计学意义的改善。在基线时伴有DO的尿失禁患者中，51%的患者在随访期间DO消失。然而，这些患者在临床上并不比仍有DO的患者更成功（P = 0.73）。在6个月随访时，84例植入患者中有55例显示出临床获益，主要排尿日记变量改善≥50%。无DO的尿失禁患者的临床成功率（73%）高于伴有DO的尿失禁患者（61%），但差异无统计学意义。
这些尿动力学结果显示，SNM术后，伴有或不伴有DO的尿失禁患者的FSF和MFV有统计学意义的改善。尽管两组在尿动力学和临床方面均有改善，但无DO的尿失禁患者至少与伴有DO的尿失禁患者一样成功。因此，对于尿失禁患者，DO不应作为使用SNM的前提选择标准。
