Hennessey Derek B, Hoag Nathan, Gani Johan
Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia.
Department of Urology, Victoria General Hospital, Victoria, British Columbia, Canada.
Neurourol Urodyn. 2017 Nov;36(8):2117-2122. doi: 10.1002/nau.23255. Epub 2017 Mar 27.
Detrusor hyperactivity with impaired contractility (DHIC) is a challenging condition to manage. Sacral neuromodulation (SNM) is a proven treatment modality for both the individual aspects of DHIC. To date, data reporting the outcome of SNM for DHIC are lacking.
Consecutive patients undergoing SNM for DHIC were followed prospectively, from April 2013 to October 2016. Patient demographics, bladder diaries, subjective response rates, ICIQ-OAB, and PGI-I scores were recorded. Success was defined as greater than 50% improvement in storage symptoms and a 50% improvement in voided volume or reduction of post-void residual volumes.
Twenty patients underwent stage 1 trial of SNM for DHIC. Median age was 68.5, IQR (54.25-76.25). Thirteen (65%) patients were female. A total of 14/20 (70%) of patients had a significant treatment response, 9/20 had a response to both elements of DHIC, 4/20 patients had a response to the detrusor overactivity (DO) alone, and 1/20 had a response to the voiding component alone. A total of 12/20 (60%) patients proceeded to insertion of an IPG. At mean follow-up of 17 months, IQR (1.5-35), 11/12 (91.7%) of patients are still using the SNM for DHIC. Median PGI score is 2, IQR (2-4). SNM for DHIC resulted in statistically significant improvements in voided volume (P = 0.016), PVR (P = 0.0296), ICIQ-OAB score (P < 0.0001), and ICIQ-OAB bother score (P = 0.016) CONCLUSION: This is the first study we know of to report the results of SNM for DHIC. SNM is associated with satisfactory success rates, treating both the detrusor hyperactivity, and impaired contractility components of this condition.
逼尿肌活动亢进伴收缩功能受损（DHIC）是一种难以处理的病症。骶神经调节（SNM）是一种已被证实的针对DHIC各个方面的治疗方式。迄今为止，缺乏关于SNM治疗DHIC结果的数据报告。
对2013年4月至2016年10月期间连续接受SNM治疗DHIC的患者进行前瞻性随访。记录患者的人口统计学数据、膀胱日记、主观反应率、ICIQ-OAB和PGI-I评分。成功定义为储尿症状改善超过50%，排尿量增加50%或残余尿量减少。
20例患者接受了DHIC的SNM一期试验。中位年龄为68.5岁，四分位间距（IQR）为（54.25 - 76.25）。13例（65%）患者为女性。总共14/20（70%）的患者有显著的治疗反应，9/20的患者对DHIC的两个方面都有反应，4/20的患者仅对逼尿肌过度活动（DO）有反应，1/20的患者仅对排尿成分有反应。总共12/20（60%）的患者进行了植入式脉冲发生器（IPG）植入。在平均17个月的随访中，IQR为（1.5 - 35），11/12（91.7%）的患者仍在使用SNM治疗DHIC。中位PGI评分为2，IQR为（2 - 4）。SNM治疗DHIC导致排尿量（P = 0.016）、残余尿量（P = 0.0296）、ICIQ-OAB评分（P < 0.0001）和ICIQ-OAB困扰评分（P = 0.016）有统计学意义的改善。
这是我们所知的第一项报告SNM治疗DHIC结果的研究。SNM具有令人满意的成功率，可治疗这种病症的逼尿肌活动亢进和收缩功能受损成分。
