Lombardi Giuseppe, Mondaini Nicola, Giubilei Gianluca, Macchiarella Angelo, Lecconi Filippo, Del Popolo Giulio
Neuro-Urology, Spinal Unit, University of Florence, Florence, Italy.
J Sex Med. 2008 Sep;5(9):2135-40. doi: 10.1111/j.1743-6109.2008.00948.x. Epub 2008 Jul 15.
The first sacral nerve stimulators were for urinary urgency incontinence, urgency-frequency, and nonobstructive urinary retention. Since then, observations have been made for benefits beyond voiding disorders.
To evaluate if sacral neuromodulation (SNM) using the InterStim system (Medtronic Inc., Minneapolis, MN, USA) improves erectile function.
From January 1999 to January 2007, 54 males, mean age 42.8, underwent a permanent SNM for lower urinary tract symptoms (LUTS). Pre-SNM only subjects with concomitant erectile impairment according to the five-item version of the International Index of Erectile Function (IIEF-5), with normal blood sexual hormonal status, and responding to an intracavernous injection test 10 microg were enrolled in our study. Three months after permanent implantation, the IIEF-5 was completed again. Those who benefited significantly in erectile function completed the IIEF-5 semiannually. A final checkup was performed in July 2007.
A score of IIEF-5 equal to or higher than 25% compared to baseline indicated remarkable clinical enhancement.
Presurgery, two patients were excluded. Overall, 22 subjects (42.3%) showed erectile impairment (14 were neurogenic). In the first visit post-SNM, five retentionists of neurogenic origin and two with overactive bladder syndrome of idiopathic origin achieved noticeable erectile improvement. Their median IIEF-5 score shifted from 14.6 to 22.2, and 15.5 to 22.5, respectively. During follow-up, two neurogenics lost the benefits concerning voiding and erection and recovered them after a new implant in the contralateral sacral S3 root. In the final visit, the seven responders reached an IIEF-5 score of at least 22.
Our study showed a clinically important benefit of sexual function mainly for neurogenic retentionists. Future research should test SNM in a larger sample of subjects, exclusively with sexual dysfunctions, in order to better understand the mechanism of action of SNM on erectile function.
首批骶神经刺激器用于治疗尿急失禁、尿频以及非梗阻性尿潴留。自那时起，人们观察到其益处不仅限于排尿障碍。
评估使用InterStim系统（美敦力公司，美国明尼阿波利斯）进行骶神经调节（SNM）是否能改善勃起功能。
1999年1月至2007年1月，54名平均年龄42.8岁的男性因下尿路症状（LUTS）接受了永久性SNM治疗。仅将那些根据国际勃起功能指数（IIEF - 5）五项版本存在勃起功能障碍、血中性激素状态正常且对10微克海绵体内注射试验有反应的患者纳入我们的研究。永久性植入三个月后，再次完成IIEF - 5评估。勃起功能有显著改善的患者每半年完成一次IIEF - 5评估。2007年7月进行了最终检查。
与基线相比，IIEF - 5评分提高25%或更高表明临床有显著改善。
术前，两名患者被排除。总体而言，22名受试者（42.3%）存在勃起功能障碍（14名是神经源性的）。在SNM后的首次随访中，5名神经源性尿潴留患者和2名特发性膀胱过度活动症患者的勃起功能有明显改善。他们的IIEF - 5评分中位数分别从14.6升至22.2以及从15.5升至22.5。在随访期间，2名神经源性患者失去了排尿和勃起方面的改善效果，在对侧骶S3神经根进行新的植入后恢复。在最终随访中，7名有反应者的IIEF - 5评分至少达到22分。
我们的研究表明，SNM对性功能有重要的临床益处，主要体现在神经源性尿潴留患者中。未来的研究应在更大规模的仅患有性功能障碍的受试者样本中测试SNM，以便更好地了解SNM对勃起功能的作用机制。
