Thompson Jannah H, Sutherland Suzette E, Siegel Steven W
Metropolitan Urology, Cornerstone Medical Specialty, 6025 Lake Road, Suite 100, Woodbury, MN, USA.
Indian J Urol. 2010 Jul;26(3):379-84. doi: 10.4103/0970-1591.70576.
Sacral neuromodulation has gained increased worldwide acceptance as the standard of care in patients with refractory overactive bladder (OAB) and non-obstructive urinary retention (NOUR). This review will detail the evolution of the technology.
The mechanism of action and advances in treatment, including tined lead, fluoroscopic imaging, and smaller implantable pulse generator (IPG) are reviewed. This discussion also explores expanding indications and future advances including interstitial cystitis, chronic pelvic pain, neurogenic bladder, fecal incontinence, constipation, and dysfunctional elimination syndrome in children.
Sacral neuromodulation (SNM) exerts its influence by modulation of sacral afferent inflow on storage and emptying reflexes. The tined lead allows for placement and stimulation to be performed in the outpatient setting under local anesthesia with mild sedation. Lead migration has been minimal and efficacy improved. The use of fluoroscopy has improved accuracy of lead placement and has led to renewed interest in bilateral percutaneous nerve evaluation (PNE). Bilateral PNE can be performed in the office setting under local anesthesia, making a trial of therapy less expensive and more attractive to patients. A smaller IPG has not only improved cosmesis, but decreased local discomfort and need for revision. The role for SNM continues to expand as clinical research identifies other applications for this therapy.
Our understanding of SNM, as well as technological advances in therapy delivery, expands the pool of patients for which this form of therapy may prove beneficial. Less invasive instrumentation may even make this form of therapy appealing to patients without refractory symptoms.
骶神经调节作为治疗难治性膀胱过度活动症（OAB）和非梗阻性尿潴留（NOUR）的标准治疗方法，已在全球范围内得到越来越广泛的认可。本综述将详细介绍该技术的发展历程。
综述了其作用机制及治疗进展，包括带倒刺电极、荧光透视成像和更小的植入式脉冲发生器（IPG）。本讨论还探讨了适应证的扩展以及未来的进展，包括间质性膀胱炎、慢性盆腔疼痛、神经源性膀胱、大便失禁、便秘和儿童功能性排尿障碍综合征。
骶神经调节（SNM）通过调节骶传入神经流入对储存和排空反射发挥作用。带倒刺电极允许在门诊局部麻醉并轻度镇静的情况下进行放置和刺激。电极移位极少，疗效得到改善。荧光透视成像的使用提高了电极放置的准确性，并重新引发了对双侧经皮神经评估（PNE）的兴趣。双侧PNE可在门诊局部麻醉下进行，使治疗试验成本更低，对患者更具吸引力。更小的IPG不仅改善了美观，还减少了局部不适和翻修需求。随着临床研究确定该疗法的其他应用，SNM的作用持续扩大。
我们对SNM的理解以及治疗方法的技术进步，扩大了可能从这种治疗形式中获益的患者群体。侵入性较小的器械甚至可能使这种治疗形式对没有难治性症状的患者也具有吸引力。
