Feldkamp Ashley, Amasyalı Akın S, Groegler Jason, Jellison Forrest, Staack Andrea
Department of Urology, Loma Linda University, Loma Linda, CA, USA.
Turk J Urol. 2021 Jan;47(1):58-65. doi: 10.5152/tud.2020.20288. Epub 2020 Oct 26.
Sacral neuromodulation (SNM) is an advanced treatment option for patients with refractory overactive bladder (OAB) symptoms, urinary retention, and bowel disorders; it is usually performed in 2 separate procedures. This study aims to determine a cohort's progression rate from stage 1 to 2 and predict factors for progression and unplanned device removal or revision.
A retrospective review was conducted in patients who underwent SNM at a single institution between June 2012 and May 2019. Progression rates from stage 1 to 2, patient characteristics, and indications for unplanned SNM removal or revision were recorded. Chi-square, Mann-Whitney U, and Fisher's exact tests were used for data analysis.
A total of 128 patients underwent SNM for 1 or more of the following diagnoses: OAB (n=103), urinary retention (n=15), neurogenic bladder dysfunction (n=4), fecal incontinence (n=2), and constipation (n=4). The progression rate to stage 2 was 92.2% (118/128). Patients who failed to progress to stage 2 had additional diagnoses other than OAB, such as urinary retention or bowel disorders (p=0.007). Fifteen patients (12.7%) required SNM removal or revision within 4 years of surgery. Among these patients, the body mass index was significantly lower (p=0.036).
Most patients (92.2%) progressed to stage 2. Patients with only OAB symptoms had a higher progression rate to stage 2. Single full-stage procedures may be considered in select patients to reduce morbidity, time, and costs.
骶神经调节（SNM）是治疗难治性膀胱过度活动症（OAB）、尿潴留和肠道疾病患者的一种先进治疗选择；通常分两个独立步骤进行。本研究旨在确定一组患者从第1阶段进展到第2阶段的比率，并预测进展以及计划外设备移除或修订的因素。
对2012年6月至2019年5月期间在单一机构接受SNM治疗的患者进行回顾性研究。记录从第1阶段到第2阶段的进展率、患者特征以及计划外SNM移除或修订的指征。采用卡方检验、曼-惠特尼U检验和费舍尔精确检验进行数据分析。
共有128例患者因以下一种或多种诊断接受了SNM治疗：OAB（n = 103）、尿潴留（n = 15）、神经源性膀胱功能障碍（n = 4）、大便失禁（n = 2）和便秘（n = 4）。进展到第2阶段的比率为92.2%（118/128）。未进展到第2阶段的患者除OAB外还有其他诊断，如尿潴留或肠道疾病（p = 0.007）。15例患者（12.7%）在手术后4年内需要进行SNM移除或修订。在这些患者中，体重指数显著较低（p = 0.036）。
大多数患者（92.2%）进展到第2阶段。仅表现为OAB症状的患者进展到第2阶段的比率更高。对于部分患者，可考虑采用单次全阶段手术以降低发病率、缩短时间并降低成本。
