Husk Katherine E, Norris Lauren D, Willis-Gray Marcella G, Borawski Kristy M, Geller Elizabeth J
Division of Female Pelvic Medicine and Reconstructive Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, 27599-7570, USA.
Department of Urology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
Int Urogynecol J. 2019 Nov;30(11):1973-1979. doi: 10.1007/s00192-019-03883-3. Epub 2019 Feb 7.
We assessed variations in sacral anatomy and lead placement as predictors of sacral neuromodulation (SNM) success. Based solely on bony landmarks, we also assessed the accuracy of the 9 and 2 protocol for locating S3.
This is a retrospective cohort study performed from October 2008 to December 2016 at the University of North Carolina at Chapel Hill. Fluoroscopic images were used to assess sacral anatomy and lead location. Success was defined as >50% symptom improvement after stage I and clinical response at most recent follow-up.
Of 249 procedures, 209 were primary implants and 40 were revisions among 187 (89.5%) women and 22 (10.5%) men. Success rate was 83.3% for primary implants and 89.4% for revisions. Success was associated with shorter implant duration (21.3 ± 22.2 vs 33.6 ± 25.8 months), higher body mass index (30.3 ± 7.8 vs 27.6 ± 6.1 kg/m), and straight vs curved lead (90.5% vs 80.5%) (all p = .05), but not with sacral anatomy or lead placement. In assessing the 9 and 2 protocol, mean distance from coccyx to S3 did not equal 9 cm: 7.4 ± 1.0 vs 7.2 ± 0.8 cm (p = .26), while mean distance from midline to S3 did equal 2 cm: 1.9 ± 0.4 vs 2.0 ± 0.7 cm (p = .37).
Variations in sacral anatomy and lead placement did not predict SNM success. The 2-cm protocol was verified while the 9-cm protocol was not, although neither was predictive of success, which may obviate the need to mark bony landmarks prior to fluoroscopy.
我们评估了骶骨解剖结构和电极放置的差异，以此作为骶神经调节（SNM）成功的预测指标。仅基于骨性标志，我们还评估了9和2方案定位S3的准确性。
这是一项回顾性队列研究，于2008年10月至2016年12月在北卡罗来纳大学教堂山分校进行。利用荧光镜图像评估骶骨解剖结构和电极位置。成功定义为I期后症状改善>50%且在最近一次随访时有临床反应。
在249例手术中，187例（89.5%）女性和22例（10.5%）男性中有209例为初次植入，40例为翻修。初次植入的成功率为83.3%，翻修的成功率为89.4%。成功与植入时间较短（21.3±22.2 vs 33.6±25.8个月）、体重指数较高（30.3±7.8 vs 27.6±6.1kg/m）以及直线型与曲线型电极（90.5% vs 80.5%）相关（所有p=0.05），但与骶骨解剖结构或电极放置无关。在评估9和2方案时，从尾骨到S3的平均距离并不等于9cm：7.4±1.0 vs 7.2±0.8cm（p=0.26），而从中线到S3的平均距离确实等于2cm：1.9±0.4 vs 2.0±0.7cm（p=0.37）。
骶骨解剖结构和电极放置的差异并不能预测SNM的成功。2cm方案得到了验证，而9cm方案未得到验证，尽管两者都不能预测成功，这可能使得在荧光镜检查前无需标记骨性标志。
