Service d'Urologie, Andrologie et Transplantation Rénale, Toulouse, France.
Neurourol Urodyn. 2011 Apr;30(4):547-50. doi: 10.1002/nau.21009.
The efficacy of sacral neuromodulation for treating refractory idiopathic lower urinary tract dysfunction is now well established. Nevertheless, results of this technique in neurological patients are still controversial. The aim of this retrospective study was to assess the results of sacral neuromodulation in neurogenic bladder dysfunction.
Between 1998 and 2008, a percutaneous nerve evaluation or a two-stage technique was performed in 62 patients (mean age 50.5 ± 14.8 years) with neurogenic lower urinary tract dysfunction. Before and during the temporary stimulation, each patient had a urodynamic evaluation and performed a bladder diary. The test was considered positive if the clinical and urodynamic improvement was over 50% and if the symptoms reappeared after turning the stimulation off.
Lower urinary tract dysfunction was detrusor overactivity in 34 cases and chronic urinary retention in 28 cases. A detrusor-sphincter dyssynergia (DSD) was associated in nine cases. Out of the 62 patients, 41 patients (66.1%) had more than 50% improvement on urodynamic evaluation and bladder diary and 37 were implanted. With a mean follow-up of 4.3 ± 3.7 years, results remained similar to the evaluation phase in 28 cases (75.7%), were partially altered in three cases (8.1%) and lost in six cases (16.2%). In these six cases, neuromodulation failed on average 12.0 ± 12.4 months after implantation.
Sacral neuromodulation seems to constitute a serious therapeutic option for patients with neurogenic lower urinary tract dysfunction. However, its results depend on the type of the underlying neurologic disease and in particular, whether it may progress or not.
骶神经调节治疗难治性特发性下尿路功能障碍的疗效已得到充分证实。然而，该技术在神经患者中的结果仍存在争议。本回顾性研究旨在评估骶神经调节治疗神经源性膀胱功能障碍的结果。
1998 年至 2008 年间，对 62 例（平均年龄 50.5±14.8 岁）神经源性下尿路功能障碍患者进行了经皮神经评估或两阶段技术。在临时刺激之前和期间，每位患者均进行了尿动力学评估和膀胱日记记录。如果临床和尿动力学改善超过 50%，且在关闭刺激后症状再次出现，则认为测试为阳性。
下尿路功能障碍为逼尿肌过度活动 34 例，慢性尿潴留 28 例。9 例存在逼尿肌括约肌协同失调（DSD）。62 例患者中，41 例（66.1%）在尿动力学评估和膀胱日记中改善超过 50%，并进行了植入。平均随访 4.3±3.7 年后，28 例（75.7%）的结果与评估阶段相似，3 例（8.1%）部分改变，6 例（16.2%）丢失。在这 6 例中，神经调节在植入后平均 12.0±12.4 个月失败。
骶神经调节似乎是治疗神经源性下尿路功能障碍患者的一种重要治疗选择。然而，其结果取决于潜在神经疾病的类型，特别是疾病是否会进展。
