Female Pelvic Medicine and Reconstructive Surgery, Section of Urology, Virginia Mason Medical Center , Seattle , Washington.
J Urol. 2019 May;201(5):973-978. doi: 10.1097/JU.0000000000000035.
Overactive bladder medications often have poor tolerability or lack of efficacy with many patients progressing to third line therapy such as sacral neuromodulation. Those treated with sacral neuromodulation may avoid the potential side effects of overactive bladder medications while achieving symptom improvement. We evaluated the postoperative rate of discontinuing overactive bladder medications in patients who underwent sacral neuromodulation of refractory overactive bladder.
We queried a prospectively collected, institutional review board approved database for patients who underwent sacral neuromodulation. Patients were excluded from analysis if the surgical indication was urinary retention or a sacral neuromodulation device was removed 1 year or less postoperatively. We assessed clinical characteristics, urodynamic parameters and filled overactive bladder medications using an external prescription database. Patient perceived postoperative outcomes were examined. Groups were compared by the Student t-test and the chi-square test.
Of the 78 patients who met inclusion criteria 82.1% stopped and never restarted overactive bladder medications (the sacral neuromodulation only group). Of the patients 14.1% consecutively continued filling overactive bladder medications 1 year or more following surgery (the concurrent group). There was no difference between the groups in body mass index, gender, sacral neuromodulation revision, urodynamic parameters, the PGI-I (Patient Global Impression of Improvement) or patient perceived percent improvement. However, concurrent patients were significantly older than those who received sacral neuromodulation only (p = 0.002).
More than 80% of patients who progressed to sacral neuromodulation discontinued overactive bladder medications and received sacral neuromodulation as the sole treatment. A small portion of patients concurrently used overactive bladder medications following sacral neuromodulation for 1 year or more. However, outcomes were similar in the 2 groups. Sacral neuromodulation is a strategy to provide a successful outcome in refractory cases and yet avoid the potentially detrimental side effects related to overactive bladder medications.
许多患有膀胱过度活动症的患者对膀胱过度活动症药物的耐受性差或疗效不佳，因此会进展到三线治疗，如骶神经调节。接受骶神经调节治疗的患者可以避免膀胱过度活动症药物的潜在副作用，同时改善症状。我们评估了接受骶神经调节治疗难治性膀胱过度活动症患者停止使用膀胱过度活动症药物的术后比率。
我们查询了一个前瞻性收集的、机构审查委员会批准的数据库，其中包括接受骶神经调节的患者。如果手术指征是尿潴留或骶神经调节装置在术后 1 年内被移除，则将患者排除在分析之外。我们使用外部处方数据库评估临床特征、尿动力学参数和填写的膀胱过度活动症药物。检查了患者术后的感知结果。通过学生 t 检验和卡方检验比较组间差异。
在符合纳入标准的 78 名患者中，82.1%（仅接受骶神经调节组）停止并从未重新开始使用膀胱过度活动症药物。在患者中，14.1%（连续使用膀胱过度活动症药物组）在手术后 1 年以上连续继续使用膀胱过度活动症药物。两组在体重指数、性别、骶神经调节修订、尿动力学参数、PGI-I（患者总体改善印象）或患者感知的改善百分比方面没有差异。然而，连续使用膀胱过度活动症药物的患者明显比仅接受骶神经调节的患者年龄大（p = 0.002）。
超过 80%进展到骶神经调节的患者停止使用膀胱过度活动症药物，并仅接受骶神经调节作为治疗方法。一小部分患者在接受骶神经调节后 1 年以上同时使用膀胱过度活动症药物。然而，两组的结果相似。骶神经调节是一种在难治性病例中提供成功结果的策略，同时避免与膀胱过度活动症药物相关的潜在有害副作用。
