Herbison G Peter, Arnold Edwin P
Department of Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand, 9054.
Cochrane Database Syst Rev. 2009 Apr 15(2):CD004202. doi: 10.1002/14651858.CD004202.pub2.
The neural control of storage and voiding of urine is complex and dysfunction can be difficult to treat. One treatment for people with refractory symptoms is continuous electrical nerve stimulation of the sacral nerve roots using implanted electrodes and an implanted pulse generator.
To determine the effects of implantable electrical stimulation devices in the treatment of urine storage and voiding problems.
We searched the Cochrane Incontinence Group Specialised Register (searched 10 February 2009), CENTRAL (The Cochrane Library 2008, Issue 1), MEDLINE (January 1980 to March 2008), EMBASE (January 1980 to March 2008), CINAHL (January 1982 to March 2008) and the reference lists of relevant articles.
Trials that tested implanted electronic stimulators connected to electrodes attached to the nerves and providing continuous electrical stimulation for neuromodulation.
Both authors selected studies, assessed quality, and extracted data.
Eight reports of randomised studies that evaluated implants which provided continuous stimulation were included. It was unclear whether some reports included patients who also appeared in other reports, so no data were pooled. In spite of this, it seems clear that continuous stimulation offers benefits for carefully selected people with overactive bladder syndrome and for those with urinary retention but no structural obstruction.Many of the implants did not work and many required revision operations. Many questions remain about patient selection and the best way to use these devices.
AUTHORS' CONCLUSIONS: In spite of methodological problems, it would appear that some people benefit from implants which provide continuous nerve stimulation. More research is needed on the best way to improve patient selection, carry out the implant, and to find why so many fail. The effectiveness of implants should be tested against other interventions, particularly in people with an overactive bladder.
尿液储存和排尿的神经控制很复杂，功能障碍可能难以治疗。对于有难治性症状的患者，一种治疗方法是使用植入电极和植入式脉冲发生器对骶神经根进行持续电神经刺激。
确定植入式电刺激装置在治疗尿液储存和排尿问题中的效果。
我们检索了Cochrane尿失禁小组专业注册库（2009年2月10日检索）、Cochrane系统评价数据库（2008年第1期）、医学索引数据库（1980年1月至2008年3月）、荷兰医学文摘数据库（1980年1月至2008年3月）、护理学与健康领域数据库（1982年1月至2008年3月）以及相关文章的参考文献列表。
测试连接到附着在神经上的电极并提供持续电刺激以进行神经调节的植入式电子刺激器的试验。
两位作者选择研究、评估质量并提取数据。
纳入了8篇评估提供持续刺激植入物的随机研究报告。不清楚某些报告中的患者是否也出现在其他报告中，因此未进行数据合并。尽管如此，似乎很明显，持续刺激对精心挑选的膀胱过度活动症患者以及有尿潴留但无结构梗阻的患者有益。许多植入物不起作用，许多需要翻修手术。关于患者选择以及使用这些装置的最佳方法仍有许多问题。
尽管存在方法学问题，但似乎有些人受益于提供持续神经刺激的植入物。需要更多研究以找到改善患者选择、进行植入的最佳方法，以及找出为何如此多植入物失败的原因。应将植入物的有效性与其他干预措施进行比较测试，尤其是在膀胱过度活动症患者中。
