Khunda Azar, Karmarkar Roopali, Abtahi Bahareh, Gonzales Gwen, Elneil Sohier
Department of Uro-neurology, National Hospital of Neurology and Neurosurgery, London WC1B 3BG, UK.
Int Urogynecol J. 2013 Jul;24(7):1201-4. doi: 10.1007/s00192-012-1999-1. Epub 2013 Feb 2.
Our aim was to determine the impact of pregnancy on sacral neuromodulation (SNM) and vice versa in patients with Fowler's syndrome (FS), which is typified by chronic urinary retention (CUR).
We performed a retrospective study of pregnancy in patients with FS who underwent a two-stage SNM implantation. Data were obtained using a standard questionnaire and clinical interview.
There were a total of ten patients with 13 pregnancies. The SNM was switched off in ten of the 13 pregnancies, with CUR recurring in nine of the ten pregnancies and recurrent urinary tract infections (UTI) occurring in four of these pregnancies (more than three UTI in the pregnancy). Those in whom the device was left on continued to void normally. One woman had a first trimester miscarriage, eight pregnancies went to term, and four deliveries were premature. Caesarean section was performed in eight pregnancies for obstetric reasons. Four pregnancies resulted in a vaginal delivery. There were no congenital anomalies reported. Following delivery, four of nine women experienced dysfunction of their SNM device when it was switched back on.
Turing off the SNM during pregnancy results in recurrence of CUR, with an increased risk of recurrent UTI associated with preterm delivery. This did not impact foetal well-being. The option of keeping the SNM on during pregnancy should therefore be considered, and as caesarean section affects the SNM device, we advise that caesarean section should only be performed for obstetric reasons.
我们的目的是确定妊娠对福勒综合征（FS）患者骶神经调节（SNM）的影响，反之亦然，FS的典型特征为慢性尿潴留（CUR）。
我们对接受两阶段SNM植入的FS患者的妊娠情况进行了回顾性研究。通过标准问卷和临床访谈获取数据。
共有10例患者，发生了13次妊娠。13次妊娠中有10次关闭了SNM，其中10次妊娠中有9次CUR复发，4次妊娠发生复发性尿路感染（UTI）（妊娠期间UTI超过3次）。那些未关闭设备的患者继续正常排尿。1名女性在孕早期流产，8次妊娠足月，4次分娩早产。因产科原因，8次妊娠进行了剖宫产。4次妊娠经阴道分娩。未报告先天性异常。分娩后，9名女性中有4名在重新开启SNM设备时出现功能障碍。
妊娠期间关闭SNM会导致CUR复发，复发性UTI风险增加，并与早产相关。这并未影响胎儿健康。因此应考虑在妊娠期间保留SNM的选择，由于剖宫产会影响SNM设备，我们建议仅因产科原因进行剖宫产。
