Department of Urology, Leiden University Medical Center, Leiden, The Netherlands; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Urology, Antwerp University Hospital, Edegem, Belgium.
Neuromodulation. 2022 Dec;25(8):1180-1186. doi: 10.1111/ner.13536. Epub 2022 Jun 14.
To evaluate if electrodiagnostic tools can advance the understanding in the effect of sacral neuromodulation (SNM) on pelvic floor activity, more specifically if SNM induces changes in pelvic floor muscle (PFM) contraction.
Single tertiary center, prospective study (October 2017-May 2018) including patients with overactive bladder syndrome undergoing SNM. Electromyography of the PFM was recorded using the Multiple Array Probe Leiden. The procedure consisted of consecutive stimulations of the lead electrodes with increasing intensity (1-3, 5, 7, 10 V). Recordings were made after electrode placement (T0) and three weeks of SNM (T1). Patients with >50% improvement were defined as responders, others as nonresponders. For the analyses, the highest electrical PFM response (EPFMR), defined as the peak-to-peak amplitude of the muscle response, was identified for each intensity. The sensitivity (intensity where the first EPFMR was registered and the normalized EPFMR as percentage of maximum EPFMR) and the evolution (EMFPR changes over time) were analyzed using linear mixed models.
Fourteen patients were analyzed (nine responders, five nonresponders). For nonresponders, the PFM was significantly less sensitive to stimulation after three weeks (T0: 1.7 V, T1: 2.6 V). The normalized EPFMR was (significantly) lower after three weeks for the ipsilateral side of the PFM for the clinically relevant voltages (1 V: 36%-23%; p = 0.024, 2 V: 56%-29%; p = 0.00001; 3 V: 63%-37%; p = 0.0002). For the nonresponders, the mean EPFMR was significantly lower at 8/12 locations at T1 (T0: 109 μV, T1: 58 μV; mean p = 0.013, range <0.0001-0.0867). For responders, the sensitivity and evolution did not change significantly.
This is the first study to describe in detail the neurophysiological characteristics of the PFM, and the changes over time upon sacral spinal root stimulation, in responders and nonresponders to SNM. More research is needed to investigate the full potential of EPFMR as a response indicator.
评估电诊断工具是否能更深入地了解骶神经调节（SNM）对盆底肌活动的影响，特别是 SNM 是否会引起盆底肌（PFM）收缩的变化。
这是一项单中心前瞻性研究（2017 年 10 月至 2018 年 5 月），纳入了接受 SNM 的膀胱过度活动症患者。使用莱顿多通道探头（Multiple Array Probe Leiden）记录 PFM 的肌电图。该过程包括以递增强度（1-3、5、7、10 V）对电极进行连续刺激。在电极放置后（T0）和 SNM 后 3 周（T1）进行记录。将改善>50%的患者定义为有反应者，其余为无反应者。对于分析，确定每个强度下的最高电 PFM 反应（EPFMR），定义为肌肉反应的峰峰值幅度。使用线性混合模型分析敏感性（记录到第一个 EPFMR 的强度以及归一化 EPFMR 作为最大 EPFMR 的百分比）和演变（EMFPR 随时间的变化）。
分析了 14 名患者（9 名有反应者，5 名无反应者）。对于无反应者，在 3 周后，PFM 对刺激的敏感性显著降低（T0：1.7 V，T1：2.6 V）。对于同侧 PFM，在临床相关电压下（1 V：36%-23%；p=0.024，2 V：56%-29%；p=0.00001，3 V：63%-37%；p=0.0002），归一化 EPFMR 显著降低。对于无反应者，T1 时 8/12 个位置的平均 EPFMR 显著降低（T0：109 μV，T1：58 μV；平均 p=0.013，范围<0.0001-0.0867）。对于有反应者，敏感性和演变均无显著变化。
这是第一项详细描述 SNM 反应者和无反应者 PFM 神经生理特征以及骶神经根刺激后随时间变化的研究。需要进一步研究以探讨 EPFMR 作为反应指标的全部潜力。
