Department of Urology, Antwerp University Hospital (UZA), Edegem, Belgium.
Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium.
Neurourol Urodyn. 2019 Feb;38(2):801-808. doi: 10.1002/nau.23925. Epub 2019 Jan 15.
Sacral neuromodulation (SNM) is an established minimally invasive therapy for functional disorders of the pelvic organs in which electrodes are stimulated in proximity of the sacral spinal nerves. Reprogramming of the electrodes is regularly required and is based on the sensory response. This study assesses the repeatability of a pelvic chart and grading system to enable a more objective assessment of the sensory response upon electrode stimulation.
In 26 SNM patients, with OAB or NOUR, assessment of the sensory response was done using the sensory threshold (ST) and a pelvic chart with 1 cm coordinates, each coordinate corresponding with a dermatome and location of sensation (LoS). A grading system was developed based upon the ST and LoS. Repeatability of ST was assessed using a two-way mixed effects, absolute agreement, single rater/measurement intraclass correlation coefficient (ICC), and displayed using a correlation and Bland Altman plot. Repeatability of dermatomes, LoS, and grading system was assessed using kappa correlation coefficient.
On average, 1.55 ± 0.85 coordinates were used to point out the area where the stimulation was perceived. The mean amount of coordinates between the area pointed at during the first and second measurement was 0.47 ± 0.74. ST showed excellent repeatability (ICC 0.93, 95%CI 0.90-0.94, P < 0.001). Dermatomes, LoS and grading system showed a substantial to almost perfect agreement (κ = 0.740-0.833, P < 0.001).
The pelvic chart and grading system, using the sensory response upon electrode stimulation, are repeatable tools and can be used to assist in follow up and troubleshooting of SNM patients.
骶神经调节（SNM）是一种成熟的微创治疗方法，用于治疗骶神经根附近的盆腔器官功能障碍。电极需要定期重新编程，编程基于感觉反应。本研究评估了盆腔图表和分级系统的可重复性，以便更客观地评估电极刺激时的感觉反应。
在 26 例患有 OAB 或 NOUR 的 SNM 患者中，使用感觉阈值（ST）和带有 1cm 坐标的盆腔图表评估感觉反应，每个坐标对应一个皮节和感觉位置（LoS）。根据 ST 和 LoS 制定了分级系统。使用双向混合效应、绝对一致、单评分者/测量者组内相关系数（ICC）评估 ST 的可重复性，并通过相关和 Bland Altman 图显示。使用kappa 相关系数评估皮节、LoS 和分级系统的可重复性。
平均使用 1.55±0.85 个坐标来指出感知刺激的区域。第一次和第二次测量所指出的区域之间的平均坐标数为 0.47±0.74。ST 显示出极好的可重复性（ICC 0.93，95%CI 0.90-0.94，P<0.001）。皮节、LoS 和分级系统显示出实质性到几乎完美的一致性（κ=0.740-0.833，P<0.001）。
使用电极刺激时的感觉反应，盆腔图表和分级系统是可重复的工具，可以用于协助 SNM 患者的随访和故障排除。
