Almutairi Sulaiman
Department of Urology, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia.
Res Rep Urol. 2020 Jun 17;12:193-197. doi: 10.2147/RRU.S258403. eCollection 2020.
Sacral neuromodulation has gained widespread use for bladder overactivity, frequency, urgency, fecal incontinence, and nonobstructive urinary retention; hence, implantations of this device in patients with comorbid cardiac conduction diseases have increased. Theoretically, there are some concerns regarding the use of sacral neuromodulation implants in patients with Wolf-Parkinson-White syndrome and cardiac conduction diseases because of the risk of interference with electrical impulses. This study aimed to describe the safety of using sacral neuromodulation to treat nonobstructive urinary retention in patients with a cardiac conduction disease. We report a case in which sacral neuromodulation was performed to treat nonobstructive urinary retention in a 25-year-old woman with Wolf-Parkinson-White syndrome who was receiving antiarrhythmic medication. The patient underwent magnetic resonance imaging of the spine and urodynamic studies after presenting with urinary symptoms at a urology clinic. She was then diagnosed with nonobstructive urinary retention. She underwent two-staged InterStim therapy, which involved implanting a permanent tined lead through the S3 foramen in the first stage and an implantable pulse generator in the second stage. The patient responded well to the therapy, and the frequency of clean intermittent catheterization was reduced from 6 times a day to once daily with only 250 mL drained per day. The cardiology team recommended intraoperative cardiac monitoring and postoperative electrocardiogram monitoring. No interference was observed between the implantable pulse generator and the cardiac rhythm on electrocardiography. She experienced no exacerbation of her cardiac symptoms. Sacral neuromodulation in a patient with Wolf-Parkinson-White syndrome appears to have been safe. Further, prospective and randomized studies with larger study samples are required to investigate the safety of these implants in WPW patients.
骶神经调节已广泛应用于膀胱过度活动症、尿频、尿急、大便失禁和非梗阻性尿潴留；因此，该装置在合并心脏传导疾病患者中的植入量有所增加。从理论上讲，由于存在干扰电冲动的风险，对于患有预激综合征和心脏传导疾病的患者使用骶神经调节植入物存在一些担忧。本研究旨在描述使用骶神经调节治疗心脏传导疾病患者非梗阻性尿潴留的安全性。我们报告了一例对一名25岁患有预激综合征且正在接受抗心律失常药物治疗的女性进行骶神经调节以治疗非梗阻性尿潴留的病例。该患者在泌尿科诊所出现泌尿系统症状后接受了脊柱磁共振成像和尿动力学检查。随后她被诊断为非梗阻性尿潴留。她接受了两阶段的InterStim治疗，第一阶段通过S3孔植入永久性带倒刺导线，第二阶段植入植入式脉冲发生器。患者对治疗反应良好，清洁间歇性导尿的频率从每天6次降至每天1次，每天仅引流250毫升。心脏病学团队建议术中进行心脏监测和术后心电图监测。心电图检查未观察到植入式脉冲发生器与心律之间存在干扰。她的心脏症状没有加重。对一名患有预激综合征的患者进行骶神经调节似乎是安全的。此外，需要更大样本量的前瞻性随机研究来调查这些植入物在预激综合征患者中的安全性。
