电刺激治疗膀胱功能障碍:技术更新

Electrical stimulation in the treatment of bladder dysfunction: technology update.

作者信息

Coolen R L, Groen J, Blok Bfm

机构信息

Department of Urology, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands.

出版信息

Med Devices (Auckl). 2019 Sep 11;12:337-345. doi: 10.2147/MDER.S179898. eCollection 2019.

Abstract

The urinary bladder has two functions: urine storage and voiding. Clinically, two major categories of lower urinary tract symptoms can be defined: storage symptoms such as incontinence and urgency, and voiding symptoms such as feeling of incomplete bladder emptying and slow urinary stream. Urgency to void with or without incontinence is called overactive bladder (OAB). Slow urinary stream, hesitancy, and straining to void with the feeling of incomplete bladder emptying are often called underactive bladder (UAB). The underlying causes of OAB or UAB can be either non-neurogenic (also referred to as idiopathic) and neurogenic, for example due to spinal cord injury or multiple sclerosis. OAB and UAB can be treated conservatively by lifestyle intervention or medication. In the case that conservative treatment does not provide sufficient benefit, electrical stimulation can be used. Sacral neurostimulation or neuromodulation (SNM) is offered as a third-line therapy to patients with non-neurogenic OAB or UAB. In SNM, the third or fourth sacral nerve root is stimulated and after a test period, a neuromodulator is implanted in the buttock. Until recently only a non-rechargeable neuromodulator was approved for clinical use. However, nowadays, a rechargeable sacral neuromodulator is also on the market, with similar safety and effectiveness to the non-rechargeable SNM system. The rechargeable device was approved for full body 1.5T and 3T MRI in Europe in February 2019. Regarding neurogenic lower urinary tract dysfunction, electrical stimulation only seems to benefit a selected group of patients.

摘要

膀胱有两项功能

储存尿液和排尿。临床上,下尿路症状可分为两大类:储尿期症状,如尿失禁和尿急;排尿期症状,如膀胱排空不全感和尿流缓慢。伴有或不伴有尿失禁的排尿急迫感称为膀胱过度活动症(OAB)。尿流缓慢、排尿犹豫以及伴有膀胱排空不全感的排尿费力通常称为膀胱活动低下(UAB)。OAB或UAB的潜在病因可以是非神经源性的(也称为特发性),也可以是神经源性的,例如由于脊髓损伤或多发性硬化症。OAB和UAB可以通过生活方式干预或药物进行保守治疗。如果保守治疗效果不佳,可以使用电刺激。骶神经刺激或神经调节(SNM)作为非神经源性OAB或UAB患者的三线治疗方法。在SNM治疗中,刺激第三或第四骶神经根,经过试验期后,在臀部植入神经调节装置。直到最近,只有不可充电的神经调节装置被批准用于临床。然而,如今,可充电骶神经调节装置也已上市,其安全性和有效性与不可充电的SNM系统相似。该可充电装置于2019年2月在欧洲被批准可用于全身1.5T和3T MRI检查。对于神经源性下尿路功能障碍,电刺激似乎仅对部分特定患者有益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1037/6750158/66cb3701a53e/MDER-12-337-g0001.jpg

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