White Wesley M, Mobley Joe D, Doggweiler Regula, Dobmeyer-Dittrich Cindy, Klein Frederick A
Division of Urologic Surgery, University of Tennessee Medical Center, Knoxville, Tennessee 37920, USA.
J Urol. 2009 Oct;182(4):1449-52. doi: 10.1016/j.juro.2009.06.049. Epub 2009 Aug 15.
We determined the long-term outcome of sacral nerve stimulation for refractory overactive bladder in the elderly population.
We performed a prospective longitudinal study to better characterize the outcome of sacral nerve stimulation in female patients 70 years old or older with refractory overactive bladder. Demographic and perioperative data were recorded. Patients were followed postoperatively for evidence of successful stage conversion, device durability and efficacy, and postoperative complications. Patients were retrospectively compared to a cohort of female patients younger than 70 years with refractory overactive bladder. Statistical analysis was performed.
Between July 2001 and February 2008, 19 elderly female patients with refractory overactive bladder underwent stage 1 lead placement. Of the patients 17 (90%) who reported greater than 50% improvement in symptoms based on a 1-week followup voiding log underwent implantable pulse generator placement. No intraoperative or immediate postoperative complications were noted. At a mean followup of 48.5 months 11 patients (65%) had a functional implantable pulse generator with greater than 50% objective improvement over baseline. Compared to matched patients younger than 70 years elderly patients had a similar conversion rate and adverse events but were significantly more likely to undergo device removal (p = 0.018).
Based on our experience elderly patients have a high conversion rate, few adverse events, and a high level of device efficacy and durability with sacral nerve stimulation. Although more mature multicenter data are needed, it appears that sacral nerve stimulation in geriatric patients is safe and efficacious, and should be judiciously offered to those with refractory voiding symptoms.
我们确定了骶神经刺激术治疗老年难治性膀胱过度活动症的长期疗效。
我们进行了一项前瞻性纵向研究，以更好地描述骶神经刺激术在70岁及以上难治性膀胱过度活动症女性患者中的疗效。记录了人口统计学和围手术期数据。对患者进行术后随访，观察成功的阶段转换、设备耐用性和疗效以及术后并发症的证据。将患者与一组年龄小于70岁的难治性膀胱过度活动症女性患者进行回顾性比较。进行了统计分析。
2001年7月至2008年2月期间，19例老年难治性膀胱过度活动症女性患者接受了第一阶段电极植入。在根据1周排尿日志报告症状改善超过50%的患者中，17例（90%）接受了植入式脉冲发生器植入。未观察到术中或术后即刻并发症。平均随访48.5个月时，11例患者（65%）拥有功能正常的植入式脉冲发生器，客观改善超过基线水平50%以上。与年龄匹配的小于70岁患者相比，老年患者的转换率和不良事件相似，但设备移除的可能性显著更高（p = 0.018）。
根据我们的经验，老年患者骶神经刺激术的转换率高、不良事件少，且设备疗效和耐用性高。尽管需要更成熟的多中心数据，但老年患者骶神经刺激术似乎是安全有效的，应谨慎地应用于那些有难治性排尿症状的患者。
