Marinkovic Serge P, Gillen Lisa M, Marinkovic Christina M
Department of Urology, Detroit Medical Center, Detroit, MI, USA.
Neuromodulation. 2015 Aug;18(6):517-21; discussion 521. doi: 10.1111/ner.12291. Epub 2015 Apr 27.
This study is an evaluation of whether motor provocation compared to mixed sensory/motor provocation for tined lead placement affects its efficacy with quality of life measurements and Likert patient satisfaction.
An observational, retrospective cohort study was conducted with the analysis of 128 charts of adult women who, between January 2002 and September 2005, underwent a two-staged approach for sacral neuromodulation by the lead author SPM. Both groups did not differ statistically in their mean preoperative American Anesthesiologist Status Classification Score's of two or less, or frequency, urgency, urgency incontinence daily episodes or Urinary Distress Inventory scores. A seven-point Likert Scale was utilized for post-operative patient satisfaction. Sixty-eight patients (Group 1) received pure motor provocation for tined lead placement under general anesthetic and 60 patients (Group 2) received mixed sensory/motor provocation tined lead placement under intravenous sedation and local anesthetic.
Sixty-two of 68 (91%) patients in Group 1 proceeded to Stage Two while 53/60 (88%) in Group 2 proceeded to Stage Two implantation (p = 0.28). Median follow-ups were 124.7 ± 21.5 months for Group 1 and 120.4 ± 19.7 months for Group 2 (p = 0.45). Mean preoperative/postoperative Urinary Distress Inventory short form and number of voids per 24 hours were for Group 1, 15.5 ± 6.6/8.9 ± 4.3 and 16.3 ± 5.3/9.2 ± 3.9 and for Group 2, 16.3 ± 6.4/8.4 ± 3.9 and 17.82 ± 7.17/8.34 ± 4.26 voids/24 hours (p < 0.001). Mean preoperative and postoperative ultrasound post void residual urines were 62.2 ± 29.3 milliliters/46.9 ± 20.6 milliliters (Group 1) and 68.0 ± 26.8 milliliters /42.0 ± 27.8 milliliters (Group 2) (p < 0.01). Mean operative times were 29.5 ± 16.8 minutes (Group 1) and 59.3 ± 25.8 minutes (Group 2) (p < 0.001). Mean Likert patient satisfaction score (1, 2, 3) for Group 1 was 2.6 and 1.8 for Group 2 (p < 0.21). The mean numbers of office visits/year for reprogramming were 1.4 ± 0.7 (Group 1) and 2.8 ± 1.1 (Group 2) (p < 0.001).
Women with mixed sensory/motor provocation tined lead placement incurred statistically significant longer operating room times and an increased number of annual reprogramming sessions. Singular motor provocation tined lead placement may, in fact, improve outcomes by significantly decreasing operating room time, improving patient satisfaction, and decreasing mean yearly reprogramming sessions, compared to mixed sensory/motor tined lead placement.
本研究旨在评估与混合感觉/运动刺激相比，采用运动刺激进行叉状电极植入对骶神经调节疗效以及生活质量测量和患者李克特满意度的影响。
进行了一项观察性回顾性队列研究，分析了2002年1月至2005年9月期间由第一作者SPM对成年女性进行的两阶段骶神经调节手术的128份病历。两组患者术前美国麻醉医师协会状态分类评分平均均为2分或更低，在频率、尿急、急迫性尿失禁每日发作次数或排尿困扰量表评分方面无统计学差异。采用七点李克特量表评估术后患者满意度。68例患者（第1组）在全身麻醉下接受纯运动刺激进行叉状电极植入，60例患者（第2组）在静脉镇静和局部麻醉下接受混合感觉/运动刺激进行叉状电极植入。
第1组68例患者中有62例（91%）进入第二阶段，第2组60例患者中有53例（88%）进入第二阶段植入（p = 0.28）。第1组的中位随访时间为124.7±21.5个月，第2组为120.4±19.7个月（p = 0.45）。第1组术前/术后排尿困扰量表简表平均分及每24小时排尿次数分别为15.5±6.6/8.9±4.3和16.3±5.3/9.2±3.9，第2组分别为16.3±6.4/8.4±3.9和17.82±7.17/8.34±4.26次/24小时（p < 0.001）。第1组术前和术后超声检查排尿后残余尿量平均分别为62.2±29.3毫升/46.9±20.6毫升，第2组分别为68.0±26.8毫升/42.0±27.8毫升（p < 0.01）。平均手术时间第1组为29.5±16.8分钟，第2组为59.3±25.8分钟（p < 0.001）。第1组患者李克特满意度平均评分（1、2、3）为2.6，第2组为1.8（p < 0.21）。每年重新编程的门诊就诊平均次数第1组为1.4±0.7次，第2组为2.8±1.1次（p < 0.001）。
与混合感觉/运动刺激叉状电极植入相比，采用混合感觉/运动刺激叉状电极植入的女性手术时间在统计学上显著更长，每年重新编程的次数增加。实际上，与混合感觉/运动叉状电极植入相比，单纯运动刺激叉状电极植入可通过显著缩短手术时间、提高患者满意度和减少每年平均重新编程次数来改善治疗效果。
