Department of Urology, Antwerp University Hospital and Faculty of Medicine, University of Antwerp, Antwerp, Belgium.
Sanford Health, Sioux Falls, South Dakota.
J Urol. 2019 Mar;201(3):573-580. doi: 10.1016/j.juro.2018.09.043.
We report 6-month efficacy and safety outcomes of selective bladder denervation in women with refractory overactive bladder.
Women with refractory overactive bladder and urgency urinary incontinence were enrolled in 2 prospective feasibility studies with the same entry criteria. They underwent selective bladder denervation of the subtrigonal region containing afferent sensory nerves. Patients were followed for 6 months and assessed for adverse events, overactive bladder symptoms and health related quality of life measures.
In the 35 women with a mean age of 66 years who were enrolled in the study all selective bladder denervation procedures were completed successfully. During 6 months of followup the symptom improvement based on 3-day bladder diaries was 59% for urgency urinary incontinence (p <0.001), 59% for urinary incontinence (p <0.001), 39% for urgency (p <0.001), 9% for urinary frequency (p = 0.01) and 27% for the total urgency and frequency score (p <0.001). Most of this treatment benefit was realized in the first month. The rate of clinical success, defined as a 50% or greater reduction in urgency urinary incontinence, was 70%, treatment benefit was reported in 75% of patients and the dry/cure rate was 27%. Statistically significant improvements during 6 months were identified on the symptom bother and health related quality of life scales on the OAB-q (Overactive Bladder Questionnaire) and on all KHQ (King's Health Questionnaire) domains except general health perception. Device or procedure related adverse events were reported in 6 patients (17%).
Pooled results of 2 prospective feasibility studies suggest that selective bladder denervation is a promising minimally invasive treatment option in women with refractory overactive bladder.
我们报告了选择性膀胱去神经支配治疗难治性膀胱过度活动症女性患者的 6 个月疗效和安全性结果。
患有难治性膀胱过度活动症和急迫性尿失禁的女性患者符合 2 项前瞻性可行性研究的相同纳入标准，接受了包含感觉传入神经的三角区下选择性膀胱去神经支配。患者随访 6 个月，评估不良事件、膀胱过度活动症症状和健康相关生活质量指标。
在 35 名平均年龄为 66 岁的女性患者中，所有选择性膀胱去神经支配手术均成功完成。在 6 个月的随访中，根据 3 天膀胱日记评估的症状改善情况为：急迫性尿失禁 59%（p＜0.001）、尿失禁 59%（p＜0.001）、急迫性 39%（p＜0.001）、尿频 9%（p=0.01）和总急迫性和频度评分 27%（p＜0.001）。这种治疗益处大部分在第一个月就得到了体现。临床成功率定义为急迫性尿失禁减少 50%或更多，为 70%，75%的患者报告有治疗获益，干燥/治愈率为 27%。OAB-q（膀胱过度活动症问卷）和所有 KHQ（King's Health Questionnaire）领域的症状困扰和健康相关生活质量评分在 6 个月内均有显著改善，除一般健康感知外。6 名患者（17%）报告了与器械或手术相关的不良事件。
2 项前瞻性可行性研究的汇总结果表明，选择性膀胱去神经支配是治疗难治性膀胱过度活动症女性患者的一种有前途的微创治疗选择。
