Meng Lingfeng, Tian Zijian, Zhang Wei, Zhang Yaoguang, Wang Jianye, Liao Limin, Ling Qing, Zhang Peng, Wei Zhongqing, Zhong Tie, Xu Zhihui, Wen Wei, Li Jiayi, Luo Deyi
Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Int J Surg. 2020 Dec;84:13-17. doi: 10.1016/j.ijsu.2020.10.007. Epub 2020 Oct 17.
Sacral neuromodulation (SNM) has been widely used to treat lower urinary tract dysfunction. Studies have shown a higher conversion rate among female patients than among male patients. However, the influence of gender on the clinical effectiveness of SNM remains unclear. We aimed to confirm whether patients of both genders show similar benefits after SNM treatment.
Clinical data of patients with lower urinary tract symptoms associated with pelvic floor dysfunction (overactive bladder, neurogenic bladder, interstitial cystitis/painful bladder syndrome, idiopathic urinary retention) treated with SNM in 10 medical centres in China between January 2012 and December 2016 were retrospectively collected. The patients were classified by gender. Variations in objective (voiding diary) and subjective scores in the baseline, testing, and last follow-up periods were compared. Data were analysed using statistical measures.
The study included 203 patients (93 males, 110 females). There were no statistical differences in baseline information between the two groups, both groups showed improvement over time. Unsatisfactory improvement was observed in the quality of life and sexual life scores of both groups over the entire treatment period (all p＞0.05). Although there was a difference in the maximum voiding volume between the groups at baseline, no difference was observed at the last follow-up (p = 0.004, p = 0.044, p = 0.124), unlike in the average volume where a difference was noted at the last follow-up (p = 0.085, p = 0.964, p = 0.031). While there were no differences in quality of life, sexual life, or pelvic pain and urinary urgency frequency scores at baseline, a significant difference was observed at the last follow-up, and the degree of improvement was less among female patients (p = 0.836, p = 0.131, p = 0.015; p = 0.294, p = 0.265, p = 0.013; p = 0.299, p = 0.087, p = 0.015).
SNM treatment elicited a similar effect on patients of both gender; however, a significant difference was observed regarding patient satisfaction with the treatment. Further preoperative patient education, especially, for female patients with interstitial cystitis/painful bladder syndrome may improve patient satisfaction.
骶神经调节（SNM）已被广泛用于治疗下尿路功能障碍。研究表明，女性患者的转换率高于男性患者。然而，性别对SNM临床疗效的影响仍不清楚。我们旨在确认SNM治疗后男女患者是否有相似的获益。
回顾性收集2012年1月至2016年12月期间在中国10个医疗中心接受SNM治疗的盆底功能障碍相关下尿路症状（膀胱过度活动症、神经源性膀胱、间质性膀胱炎/疼痛性膀胱综合征、特发性尿潴留）患者的临床资料。患者按性别分类。比较基线期、测试期和末次随访期客观（排尿日记）和主观评分的变化。采用统计学方法分析数据。
该研究纳入203例患者（93例男性，110例女性）。两组患者的基线信息无统计学差异，两组患者均随时间有所改善。在整个治疗期间，两组患者的生活质量和性生活评分改善均不理想（均p＞0.05）。虽然两组患者基线期的最大排尿量存在差异，但末次随访时未观察到差异（p = 0.004，p = 0.044，p = 0.124），而平均尿量在末次随访时存在差异（p = 0.085，p = 0.964，p = 0.031）。虽然两组患者基线期的生活质量、性生活或盆腔疼痛及尿急频率评分无差异，但末次随访时观察到显著差异，且女性患者的改善程度较小（p = 0.836，p = 0.131，p = 0.015；p = 0.294，p = 0.265，p = 0.013；p = 0.299，p = 0.087，p = 0.015）。
SNM治疗对男女患者均产生相似的效果；然而，在患者对治疗的满意度方面观察到显著差异。进一步的术前患者教育尤其是对间质性膀胱炎/疼痛性膀胱综合征的女性患者，可能会提高患者满意度。
