Department of Urology, University of Iowa, Iowa City, Iowa 52242-1089, USA.
J Urol. 2010 Jan;183(1):173-6. doi: 10.1016/j.juro.2009.08.142.
We present our long-term experience with sacral neuromodulation devices placed in patients with painful bladder syndrome to determine whether the benefit decreases over time.
Between January 2000 and July 2004, 32 women and 7 men with interstitial cystitis/painful bladder syndrome in whom previous conventional therapy failed underwent sacral neuromodulation test stimulation. Before 2003 a percutaneous test lead was placed in the clinic setting. After 2003 a quadripolar permanent lead was placed in the operating room. Permanent generators were implanted if the patient had more than 50% relief from the presenting complaint, which was defined as urinary or pelvic pain, urgency, or urinary frequency. Long-term outcomes included battery depletion, device malfunction, infection or loss of benefit as well as any change in need for medications.
Of 39 patients 22 went from test stimulation to permanent generator implantation. There were significant differences in short-term but not long-term outcomes between the 2 methods of test stimulation. Of 33 patients undergoing percutaneous nerve evaluation 13 (39.4%) met the criteria for permanent generator implantation, while 9 of 11 (81.8%) evaluated with the quadripolar lead met these criteria (p = 0.015). Long-term success between the groups was similar at 92.3% (12 of 13) vs 77.8% (7 of 9) (p = 0.329) during an average followup of 59.9 months. Eleven (50.0%) devices required explantation. Of 22 patients 3 (13.6%) lost benefit over time.
These patients appear to respond best to permanent quadripolar lead placement but long-term results do not appear to be independently affected by the method of test stimulation. Loss of benefit over time is not common.
我们介绍了在患有膀胱疼痛综合征的患者中放置骶神经调节装置的长期经验，以确定其益处是否随时间而降低。
在 2000 年 1 月至 2004 年 7 月期间，32 名女性和 7 名男性患有间质性膀胱炎/膀胱疼痛综合征，先前的常规治疗失败，接受了骶神经调节测试刺激。在 2003 年之前，在诊所环境中放置了经皮测试引线。在 2003 年之后，在手术室中放置了四极永久引线。如果患者对出现的投诉有超过 50%的缓解，即定义为尿或盆腔疼痛、尿急或尿频，则植入永久性发生器。长期结果包括电池耗尽、设备故障、感染或失去益处以及对药物需求的任何变化。
在 39 名患者中，有 22 名从测试刺激转为永久性发生器植入。两种测试刺激方法的短期结果有显著差异，但长期结果没有差异。在接受经皮神经评估的 33 名患者中，有 13 名（39.4%）符合永久性发生器植入标准，而在接受四极引线评估的 11 名患者中，有 9 名（81.8%）符合这些标准（p=0.015）。两组的长期成功率相似，分别为 92.3%（12 名中的 13 名）和 77.8%（9 名中的 7 名）（p=0.329），平均随访时间为 59.9 个月。有 11 名（50.0%）设备需要取出。在 22 名患者中，有 3 名（13.6%）随着时间的推移失去了益处。
这些患者似乎对永久性四极引线放置反应最好，但长期结果似乎不受测试刺激方法的独立影响。随着时间的推移失去益处并不常见。
