Tutolo Manuela, Ammirati Enrico, Heesakkers John, Kessler Thomas M, Peters Kenneth M, Rashid Tina, Sievert Karl-Dietrich, Spinelli Michele, Novara Giacomo, Van der Aa Frank, De Ridder Dirk
Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Department of Urology, Ospedale San Giovanni Battista, Turin, Italy.
Eur Urol. 2018 Mar;73(3):406-418. doi: 10.1016/j.eururo.2017.11.002. Epub 2018 Jan 12.
Neuromodulation is considered in patients with non-neurogenic lower urinary tract dysfunction (LUTD) not responsive to conservative treatment.
To systematically review the available studies on efficacy and safety of sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) in non-neurogenic LUTDs not responsive to conservative treatments.
A literature research was conducted in PubMed/Medline and Scopus, restricted to articles in English, published between January 1998 and June 2017, with at least 20 patients and 6 mo of follow-up.
Twenty-one reports were identified. Concerning SNM, the improvement of ≥50% in leakage episodes ranged widely between 29% and 76%. Overall dry rate ranged between 43% and 56%. Overall success/improvement rate in PTNS varied between 54% and 59%. Symptom improvement or efficacy in interstitial cystitis/bladder pain syndrome patients appeared to be lower compared with other indications in both techniques. Safety data showed fewer side effects in patients submitted to PTNS.
Neuromodulation gives good results and is a safe therapy for patients with overactive bladder or chronic nonobstructive urinary retention with long-lasting efficacy. Moreover, PTNS has been shown to have good success rates and fewer side effects compared with SNM. These data have to be confirmed with long-term follow-up.
Sacral neuromodulation can improve low urinary tract symptoms in selected patients; it appears to be a safe therapy for nonresponders to standard medical therapies. Percutaneous tibial nerve stimulation (PTNS) is a less invasive technique that gives good results in short time with fewer side effects. However, we must consider that PTNS has not been tested in the long term and results are lower if compared with SNM.
对于保守治疗无反应的非神经源性下尿路功能障碍（LUTD）患者，可考虑采用神经调节治疗。
系统评价骶神经调节（SNM）和经皮胫神经刺激（PTNS）治疗对保守治疗无反应的非神经源性LUTD的有效性和安全性的现有研究。
在PubMed/Medline和Scopus数据库中进行文献检索，检索范围限定为1998年1月至2017年6月发表的英文文章，纳入至少20例患者且随访时间至少6个月的研究。
共识别出21篇报告。关于SNM，漏尿发作改善≥50%的比例在29%至76%之间广泛波动。总体干爽率在43%至56%之间。PTNS的总体成功/改善率在54%至59%之间。在这两种技术中，间质性膀胱炎/膀胱疼痛综合征患者的症状改善或疗效似乎低于其他适应证。安全性数据显示，接受PTNS治疗的患者副作用较少。
神经调节对膀胱过度活动症或慢性非梗阻性尿潴留患者疗效良好且是一种安全的治疗方法，具有持久的疗效。此外，与SNM相比，PTNS已显示出较高的成功率和较少的副作用。这些数据必须通过长期随访加以证实。
骶神经调节可改善部分患者的下尿路症状；对于对标准药物治疗无反应的患者，它似乎是一种安全的治疗方法。经皮胫神经刺激（PTNS）是一种侵入性较小的技术，短期内效果良好且副作用较少。然而，我们必须考虑到PTNS尚未进行长期测试，与SNM相比结果较低。
