Department of Urology, Western Health, University of Melbourne, Melbourne, Australia.
Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia.
Neurourol Urodyn. 2021 Jun;40(5):1078-1088. doi: 10.1002/nau.24694. Epub 2021 May 11.
The aim of this systematic review is to provide an updated report on the efficacy and complications of sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic nonobstructive urinary retention (CNOUR), with a focus on the contemporary technique of SNM utilizing the percutaneous placement of tined leads.
This systematic review was conducted with the use of PRISMA guidelines and registered with PROSPERO (CRD42020208052). A systematic literature search was conducted in Embase, PubMed, and Cochrane databases. Inclusion criteria include English language and human participants. Exclusion criteria include SNM studies involving less than 10 CNOUR patients, studies containing data obtained using open, surgical implantation of nontined leads, and studies that only reported the test phase success rate with no long-term efficacy data. The risk of bias assessment was conducted using the National Institutes of Health study quality assessment tool.
A total of 16 papers studies were included (11 SNM and 5 PTNS) in this review. The success rate for SNM ranges between 42.5% and 100% (median = 79.2%) for the test stimulation phase and 65.5%-100% (median = 89.1%) in the long term. Most SNM studies reported revision and explantation rates of lesser than 20%. The success rate was much lower for PTNS, in the 50%-60% range and complications were minimal.
SNM using the contemporary percutaneous tined lead implantation technique appears to be an effective treatment for CNOUR and is durable in the long term. Compared to SNM, PTNS appears less efficacious with less evidence supporting its use in CNOUR. Further prospective studies are required to define the role of PTNS in the treatment of CNOUR.
本系统评价的目的是提供一份关于骶神经调节（SNM）和经皮胫神经刺激（PTNS）治疗慢性非梗阻性尿潴留（CNOUR）的疗效和并发症的最新报告，重点介绍使用经皮放置叉状电极的当代 SNM 技术。
本系统评价按照 PRISMA 指南进行，并在 PROSPERO（CRD42020208052）中进行了注册。在 Embase、PubMed 和 Cochrane 数据库中进行了系统文献检索。纳入标准包括英语和人类参与者。排除标准包括涉及少于 10 例 CNOUR 患者的 SNM 研究、包含使用开放式、手术植入非叉状电极获得的数据的研究，以及仅报告测试阶段成功率而无长期疗效数据的研究。使用美国国立卫生研究院研究质量评估工具进行偏倚风险评估。
本综述共纳入 16 项研究（11 项 SNM 和 5 项 PTNS）。SNM 的测试刺激阶段成功率在 42.5%-100%之间（中位数=79.2%），长期成功率在 65.5%-100%之间（中位数=89.1%）。大多数 SNM 研究报告的修订和取出率低于 20%。PTNS 的成功率较低，在 50%-60%之间，并发症较少。
使用当代经皮叉状电极植入技术的 SNM 似乎是治疗 CNOUR 的有效方法，并且长期效果持久。与 SNM 相比，PTNS 的疗效较低，支持其在 CNOUR 中应用的证据较少。需要进一步的前瞻性研究来确定 PTNS 在治疗 CNOUR 中的作用。
