Saber-Khalaf Mohammed, Abtahi Bahareh, Gonzales Gwen, Helal Mohamed, Elneil Sohier
Department of Uro-neurology, National Hospital for Neurology and Neurosurgery, London, UK.
Neuromodulation. 2015 Jun;18(4):329-34; discussion 334. doi: 10.1111/ner.12268. Epub 2015 Feb 5.
To assess the outcome of two-stage sacral neuromodulation (SNM) in men with chronic urinary retention (CUR) and factors affecting the response.
Data were collected from 21 male patients with complete or partial CUR who underwent two-stage SNM between 2006 and 2014. The implanted lead was connected to a temporary battery (stage-1) and they were assessed over a period of 3-12 weeks. Those who had a residual volume of ≤100 mL, had an implantable pulse generator sited (stage-2). Patients were followed up at 3 and 6 months initially, and 12 monthly thereafter. The following parameters were analyzed: age, onset of symptoms, precipitant causes for CUR, type of retention, associated voiding dysfunction and opiate intake.
Surgery was the main precipitating cause of CUR in 5 (24%) patients. Stage-1 SNM restored complete efficient voiding in 14 patients (66.7%) out of the 21 patients. The only parameter studied that showed a positive correlation with a successful outcome to SNM was the age of the patient, with a higher success rate in younger males (median age 37 years [p = 0.025]). There was no other significant finding when looking at other parameters studied. Stage-2 was carried out in 13 out of 14 successful stage-1 patients. SNM restored complete voiding or improved bladder emptying in all patients implanted with a battery, and this was sustained until the battery needed to be replaced with a mean follow up of 34 ± 23.7 months except in two cases that had removal after traumatic accidents.
Stage-1 SNM was successful in 66.7% of male patients with CUR. Once stage-2 was performed, successful voiding was maintained until the battery needed to be replaced. SNM success was better in men under a median age of 43 years. Further studies are encouraged to study this group of patients.
评估两阶段骶神经调节（SNM）治疗男性慢性尿潴留（CUR）的疗效及影响反应的因素。
收集2006年至2014年间接受两阶段SNM治疗的21例男性完全性或部分性CUR患者的数据。植入的电极与临时电池相连（第一阶段），并在3至12周的时间内对他们进行评估。残余尿量≤100 mL的患者植入可植入式脉冲发生器（第二阶段）。患者最初在3个月和6个月时进行随访，此后每月随访1次。分析以下参数：年龄、症状出现时间、CUR的诱发原因、尿潴留类型、相关排尿功能障碍及阿片类药物摄入量。
手术是5例（24%）患者CUR的主要诱发原因。21例患者中，14例（66.7%）在第一阶段SNM后恢复了完全有效的排尿。所研究的唯一与SNM成功结果呈正相关的参数是患者年龄，年轻男性成功率更高（中位年龄37岁[p = 0.025]）。在研究其他参数时未发现其他显著结果。14例第一阶段成功的患者中有13例进行了第二阶段治疗。SNM使所有植入电池的患者恢复了完全排尿或改善了膀胱排空，并且这种情况一直持续到需要更换电池，平均随访34±23.7个月，除了2例在创伤性事故后取出的病例。
第一阶段SNM在66.7%的男性CUR患者中取得成功。一旦进行了第二阶段治疗，成功排尿得以维持，直到需要更换电池。年龄中位数43岁以下的男性SNM成功率更高。鼓励进一步研究这组患者。
