Department of Neuro-urology, Florence, Italy.
Spinal Cord. 2013 Sep;51(9):688-93. doi: 10.1038/sc.2013.64. Epub 2013 Jul 9.
To evaluate the efficacy and safety over a 10-year period of any urological operations required by female patients with spinal cord lesions (SCLs).
Retrospective study of urological surgeries from our database performed on females with SCLs from 2001 to 2002. Surgery efficacy for neurogenic lower urinary tract dysfunctions (N-LUTDs) was evaluated by comparing 7-day voiding diaries pre- and post-surgeries, while individual investigations were done pre- and post-surgery to evaluate urological complications. Drawbacks were assessed.
Thirty-eight out of 69 patients underwent one or more urological procedures. Twenty-one out of 42 patients with suprasacral lesions underwent interventions for N-LUTD. The main surgical treatment was endoscopic detrusor infiltration of botulinum-A (Botox 300 UI or Dysport 750 UI) performed 107 times on 15 subjects using aseptic intermittent catheterizations for neurogenic overactive bladder. Mean efficacy duration was 9.2 months. Six females with infrasacral lesions underwent at least one intervention for N-LUTD. Two females in each group underwent tension-free vaginal tape for stress urinary incontinence (SUI), reducing episodes per week of SUI by >90% after 5 years. The most serious urological complication was active vesico-ureteral reflux (VUR) in three patients, treated endoscopically with submucosal injection of Macroplastique. No VUR recurrence was detected during a 6-year follow-up. All bladder stones (five cases) and renal calculi (five cases) were treated with endoscopic transurethrally electrohydraulic lithotripsy and extracorporeal shock-wave lithotripsy, respectively. Overall, no serious drawbacks were observed.
Mini-invasive surgeries were exclusively used to address urological issues in chronic SCL patients.
评估女性脊髓损伤（SCL）患者在 10 年内需要进行的任何泌尿科手术的疗效和安全性。
回顾性研究 2001 年至 2002 年期间数据库中接受过 SCL 女性泌尿科手术的患者。通过比较手术前后 7 天的排尿日记来评估神经源性下尿路功能障碍（N-LUTD）的手术疗效，同时对术前和术后的个体进行调查，以评估泌尿科并发症。评估了不足之处。
69 名患者中有 38 名接受了一次或多次泌尿科手术。21 名上运动神经元损伤患者接受了 N-LUTD 干预。主要手术治疗是使用无菌间歇性导尿对神经源性逼尿肌过度活动症患者进行 15 次 300 UI 肉毒杆菌毒素-A（Botox）或 750 UI Dysport 膀胱内注射。平均疗效持续时间为 9.2 个月。6 名下运动神经元损伤患者至少接受了一次 N-LUTD 干预。每组中有 2 名女性患者接受了无张力阴道吊带术（TVT）治疗压力性尿失禁（SUI），5 年后每周 SUI 发作次数减少了>90%。最严重的泌尿科并发症是 3 名患者出现活跃性膀胱输尿管反流（VUR），经内镜黏膜下注射 Macroplastique 治疗。在 6 年的随访中未发现 VUR 复发。所有膀胱结石（5 例）和肾结石（5 例）均经经尿道电切碎石术和体外冲击波碎石术治疗。总体而言，未观察到严重的缺点。
微创外科手术专门用于解决慢性 SCL 患者的泌尿科问题。
