Department of Urology, Antwerp University Hospital, Edegem, Belgium.
University of Antwerp, Antwerpen, Belgium.
J Urol. 2021 Jan;205(1):206-212. doi: 10.1097/JU.0000000000001317. Epub 2020 Jul 27.
We sought to determine whether prolonged interventional test phase increases cumulative success rate and compared success rates between early responders (ie within 1 week) and those in need for reprogramming (due to lack of efficacy) of sacral neuromodulation after 1-year followup.
In a single tertiary center prospective study (August 2015 to November 2018) 90 patients refractory to first line treatment were eligible for sacral neuromodulation, including 48 overactive bladder wet (53%), 8 overactive bladder dry (9%) and 34 nonobstructive urinary retention (38%). Patients were evaluated at weekly intervals during test phase and those not successful were reprogrammed. This could be repeated after the second week. Primary outcome was success rate after 3-week test phase and after 1-year followup. Statistical analysis was done by nonparametric tests for numeric (Mann-Whitney U) and categorical (chi) data.
After 3 weeks of test period 56 patients (62%) were considered successful. Prolonged interventional testing increased cumulative success. A 1-year followup showed no significant difference in success rate between early responders and those in need for reprogramming (chi, p=0.562). There was no difference in age (Mann-Whitney U, p=0.222), sex (chi, p=0.952) or indication (chi, p= 0.975).
A 3-week test phase with close followup increases cumulative success rate. During this supervised 3-week test phase 42% of the initial nonresponders after the first week became successful candidates after reprogramming. Patients who required this additional programming did equally as well as those without need for reprogramming. A supervised 3-week test phase is therefore strongly recommended.
我们旨在确定延长介入性测试阶段是否会提高累积成功率，并比较骶神经调节治疗 1 年后早期应答者（即在 1 周内）和因疗效不佳而需要重新程控（即无应答）的成功率。
在单中心前瞻性研究中（2015 年 8 月至 2018 年 11 月），90 例对一线治疗无反应的患者符合骶神经调节的条件，其中包括 48 例逼尿症湿（53%）、8 例逼尿症干（9%）和 34 例非梗阻性尿潴留（38%）。患者在测试阶段每星期进行评估，无应答者进行重新程控。如果第二周仍无应答，则可重复该过程。主要结局是 3 周测试期后的成功率和 1 年随访后的成功率。采用非参数检验（Mann-Whitney U 检验用于数值数据，chi 检验用于分类数据）进行统计分析。
在 3 周测试期结束后，有 56 例（62%）患者被认为是成功的。延长介入性测试可提高累积成功率。1 年随访显示，早期应答者和需要重新程控的患者之间的成功率无显著差异（chi，p=0.562）。年龄（Mann-Whitney U，p=0.222）、性别（chi，p=0.952）或适应证（chi，p=0.975）无差异。
进行 3 周的测试阶段并密切随访可提高累积成功率。在这个有监督的 3 周测试阶段，最初第 1 周无应答的 42%患者在重新程控后成为成功的候选者。需要进行重新程控的患者与无需重新程控的患者效果相同。因此，强烈推荐进行 3 周的有监督测试阶段。
