Meng Lingfeng, Diao Tongxiang, Wang Miao, Liu Xiaodong, Zhang Wei, Tian Zijian, Wang Jianye, Zhang Yaoguang
Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Transl Androl Urol. 2020 Dec;9(6):2842-2847. doi: 10.21037/tau-20-889.
Overactive bladder (OAB) is a common urological disease, reducing patient quality of life (QoL). Sacral neuromodulation (SNM) is a treatment option used when conservative treatment is inadequate. However, constant frequency stimulation-SNM (CFS-SNM) may not be sufficiently effective in achieving targeted symptom reduction in some patients. For such black-zone patients, a different treatment strategy is needed. Variable frequency stimulation (VFS) has been used for deep-brain stimulation treatment in patients with Parkinson's disease with positive outcomes. Accordingly, in this study, we hypothesized the promising outcomes of VFS-SNM in black-zone OAB patients. Here, we evaluated the efficacy and safety of VFS-SNM viz-a-viz CFS-SNM in a black-zone patient with refractory OAB whose frequent micturition symptoms were not relieved after undergoing traditional conservative treatment. A 50-year-old male patient was treated with CFS-SNM at our hospital in October 2016, but his symptoms recurred after administering multiple medications and program-controlled parameter adjustments. We then treated the patient with VFS-SNM in March 2020. A 2-week follow-up through telephonic interviews was conducted; the improvements in voiding symptoms were evaluated by calculating the OAB symptom score (OABSS) and OAB-related QoL (OAB-QoL) score. We observed that OABSS was significantly lower after VFS-SNM than after CFS-SNM. Further, we observed that VFS-SNM significantly improved daytime and nocturnal micturition frequency, as evident from the reduced OABSSs from after CFS-SNM to after VFS-SNM. The main reason for patient dissatisfaction after CFS-SNM was the increased average daily micturition frequency and urgency. VFS-SNM controlled the micturition frequency to within the patient's acceptable range, significantly improving the patient's QoL (40% improvement in OAB-QoL score). To the best of our knowledge, this is the first case report on the use of VFS-SNM with positive outcomes in a black-zone OAB patient, suggesting that VFS-SNM is not inferior to CFS-SNM in the treatment of black-zone patients.
膀胱过度活动症（OAB）是一种常见的泌尿系统疾病，会降低患者的生活质量（QoL）。骶神经调节（SNM）是在保守治疗不足时使用的一种治疗选择。然而，在一些患者中，固定频率刺激 - SNM（CFS - SNM）在实现目标症状减轻方面可能不够有效。对于这类处于“黑区”的患者，需要不同的治疗策略。可变频率刺激（VFS）已用于帕金森病患者的深部脑刺激治疗，并取得了积极成果。因此，在本研究中，我们假设VFS - SNM对处于“黑区”的OAB患者会有良好效果。在此，我们评估了VFS - SNM与CFS - SNM相比，在一名患有难治性OAB的“黑区”患者中的疗效和安全性，该患者在接受传统保守治疗后，尿频症状未得到缓解。一名50岁男性患者于2016年10月在我院接受CFS - SNM治疗，但在多次用药和程控参数调整后症状复发。然后我们在2020年3月对该患者进行了VFS - SNM治疗。通过电话访谈进行了为期2周的随访；通过计算OAB症状评分（OABSS）和与OAB相关的生活质量（OAB - QoL）评分来评估排尿症状的改善情况。我们观察到，VFS - SNM后的OABSS显著低于CFS - SNM后的OABSS。此外，我们观察到VFS - SNM显著改善了白天和夜间的排尿频率，从CFS - SNM后到VFS - SNM后的OABSS降低可以明显看出。CFS - SNM后患者不满意的主要原因是平均每日排尿频率增加和尿急。VFS - SNM将排尿频率控制在患者可接受范围内，显著改善了患者的生活质量（OAB - QoL评分提高了40%）。据我们所知，这是第一例关于在“黑区”OAB患者中使用VFS - SNM并取得积极成果的病例报告，表明VFS - SNM在治疗“黑区”患者方面并不逊色于CFS - SNM。
