Spinelli Michele, Sievert Karl-Dietrich
Unità Spinale Unipolare, Azienda Ospedale Niguarda Cà Granda, Milan, Italy.
Eur Urol. 2008 Dec;54(6):1287-96. doi: 10.1016/j.eururo.2008.01.076. Epub 2008 Feb 8.
This article accompanies a "surgery in motion" DVD on sacral neuromodulation (SNM) with InterStim Therapy, which visualizes the implantation of the InterStim II system. The article describes the technical and surgical developments of SNM and their impact on treatment success, safety, and patient's quality of life (QoL).
Relevant literature on SNM with regard to technical changes and related clinical outcomes has been reviewed.
Since its introduction in the early 1990s, SNM has proven useful in the treatment of several types of chronic urinary (and bowel) dysfunction. Recent technical improvements in devices and, in particular, the introduction of the tined lead 5 yr ago made SNM progress from an elaborate, open-surgery, general anesthesia, one-stage implant procedure to a minimally invasive, local anesthesia, percutaneous technique in two stages. The permanent tined lead implant enables a longer patient testing period (minimum of 14 d recommended) and less lead migration. This has considerably reduced technical failures and improved the success rate of the test phase; the response rate was almost doubled to approximately 80%. These improvements also affected tolerability, resulting in increased QoL for the patient. The use of the recently introduced smaller implantable neurostimulator InterStim II seems to further improve patient comfort and makes the implant procedure for the physician easier and shorter. However, this must be further addressed in clinical studies.
SNM with InterStim Therapy using the tined lead offers an efficient treatment modality for patients in whom conservative treatment has failed.
本文配有一张关于骶神经调节（SNM）与InterStim疗法的“动态手术”DVD，该DVD展示了InterStim II系统的植入过程。本文描述了SNM的技术和手术进展及其对治疗成功率、安全性和患者生活质量（QoL）的影响。
回顾了关于SNM技术变化及相关临床结果的相关文献。
自20世纪90年代初引入以来，SNM已被证明可有效治疗多种类型的慢性泌尿系统（和肠道）功能障碍。近年来设备的技术改进，尤其是5年前引入的带倒刺电极，使SNM从一种复杂的、开放手术、全身麻醉、一期植入手术发展为一种微创、局部麻醉、经皮分两期进行的技术。永久性带倒刺电极植入可使患者测试期更长（建议至少14天）且电极移位更少。这大大减少了技术故障并提高了测试阶段的成功率；反应率几乎翻了一番，达到约80%。这些改进也影响了耐受性，提高了患者的生活质量。最近推出的体积更小的可植入神经刺激器InterStim II的使用似乎进一步提高了患者的舒适度，使医生的植入手术更轻松、更快捷。然而，这一点必须在临床研究中进一步探讨。
使用带倒刺电极的InterStim疗法进行SNM为保守治疗失败的患者提供了一种有效的治疗方式。
