Chen Guoqing, Wang Yiming, Ying Xiaoqian, Pang Dongqing, Liao Limin
Department of Urology, Beijing Boai Hospital, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Nov 15;35(11):1374-1379. doi: 10.7507/1002-1892.202105112.
To evaluate the effectiveness and safety of sacral neuromodulation (SNM) in the treatment of neurogenic bladder and bowel dysfunction in patients with spina bifida.
The clinical data of 33 patients with neurogenic bladder and bowel dysfunction caused by spina bifida treated with SNM between July 2012 and May 2021 were retrospectively analyzed. There were 19 males and 14 females, with an average age of 26.0 years (range, 18.5-36.5 years). The disease duration ranged from 12 to 456 months, with an average of 195.8 months. The types of spina bifida included 8 cases of occult spina bifida and 25 cases of meningocele/myelomeningocele. Clinical symptoms included 19 cases of urgency-frequent urination, 18 cases of urinary incontinence, 27 cases of chronic urinary retention, and 29 cases of bowel dysfunction. Image urodynamics showed that 4 patients had detrusor overactivity (DO) and 29 patients had detrusor underactivity (DU). Vesicoureteral reflux (VUR) was found in 5 ureters (4 patients). SNM procedure was divided into experiential treatment and permanent implantation. Patients who were evaluated as successful or willing to be permanently implanted after experiential treatment would implant the permanent pulse generator.
The duration of experiential treatment was 14-28 days, with an average of 19.2 days; there was no complication during this period, and the overall success rate was 69.69% (23/33). At the end of experiential treatment, the urination frequency in 24 hours, urine volume per time, urinary urgency score, and urine leakage of patients were significantly improved when compared with those before experiential treatment ( <0.05); there was no significant difference in postvoid residual volume between before and after experiential treatment ( =1.383, =0.179). The success rate of patients with chronic urinary retention after experiential treatment (25.93%) was significantly lower than that of urgency-frequent urination (63.16%) and urinary incontinence (61.11%) ( =7.260, =0.064). Compared with those before experiential treatment, the maximum cystometric capacity and compliance increased and the maximum detrusor pressure during filling decreased significantly ( <0.05). Among the 4 patients with DO before experiential treatment, DO disappeared in 2 cases; 27 patients with DU before experiential treatment did not recover the normal contraction of detrusor during micturition. Among the 5 ureters with VUR before experiential treatment, 2 VUR disappeared at the end of experiential treatment, and the VUR grade or the bladder volume before VUR of the other 3 ureters were improved. At the end of experiential treatment, the neurogenic bowel dysfunction (NBD) score and the grade of bowel dysfunction significantly improved ( <0.05). A total of 19 patients received permanent implantation, of which 11 patients needed to empty the bladder in combination with intermittent catheterization.
SNM is effective for neurogenic bladder and bowel dysfunction in patients with spina bifida. At the same time, it can significantly improve the urodynamic parameters during urine storage and avoid upper urinary tract damage.
评估骶神经调节（SNM）治疗脊柱裂患者神经源性膀胱和肠道功能障碍的有效性和安全性。
回顾性分析2012年7月至2021年5月间33例因脊柱裂导致神经源性膀胱和肠道功能障碍并接受SNM治疗患者的临床资料。其中男性19例，女性14例，平均年龄26.0岁（范围18.5 - 36.5岁）。病程12至456个月，平均195.8个月。脊柱裂类型包括隐性脊柱裂8例，脊膜膨出/脊髓脊膜膨出25例。临床症状包括尿急尿频19例、尿失禁18例、慢性尿潴留27例、肠道功能障碍29例。影像尿动力学检查显示4例逼尿肌过度活动（DO），29例逼尿肌活动低下（DU）。5条输尿管（4例患者）发现膀胱输尿管反流（VUR）。SNM手术分为经验性治疗和永久性植入。经验性治疗后评估为成功或愿意接受永久性植入的患者将植入永久性脉冲发生器。
经验性治疗时间为14 - 28天，平均19.2天；此期间无并发症发生，总体成功率为69.69%（23/33）。经验性治疗结束时，患者24小时排尿次数、每次尿量、尿急评分及漏尿情况与经验性治疗前相比均显著改善（<0.05）；经验性治疗前后残余尿量差异无统计学意义（=1.383，=0.179）。经验性治疗后慢性尿潴留患者成功率（25.93%）显著低于尿急尿频（63.16%）和尿失禁患者（61.11%）（=7.260，=0.064）。与经验性治疗前相比，最大膀胱测压容量和顺应性增加，充盈期最大逼尿肌压力显著降低（<0.05）。经验性治疗前4例DO患者中，2例DO消失；经验性治疗前27例DU患者排尿时逼尿肌未恢复正常收缩。经验性治疗前5条有VUR的输尿管中，经验性治疗结束时2条VUR消失，另外3条输尿管VUR分级或VUR前膀胱容量得到改善。经验性治疗结束时神经源性肠道功能障碍（NBD）评分及肠道功能障碍分级显著改善（<0.05）。共有19例患者接受永久性植入，其中11例患者需结合间歇性导尿排空膀胱。
SNM对脊柱裂患者神经源性膀胱和肠道功能障碍有效。同时可显著改善储尿期尿动力学参数并避免上尿路损害。
