Coolen Rosa L, Groen Jan, Stillebroer Alexander B, Scheepe Jeroen R, Witte Lambertus P W, Blok Bertil F M
Department of Urology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands.
Department of Urology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands.
Neuromodulation. 2023 Dec;26(8):1823-1830. doi: 10.1016/j.neurom.2022.04.042. Epub 2022 Jun 9.
The aims of this study were to 1) determine the success rate of the tined lead test phase in patients with nonobstructive urinary retention (NOUR), 2) determine predictive factors of a successful test phase in patients with NOUR, and 3) determine long-term treatment efficacy and satisfaction in patients with NOUR.
The first part was a multicenter retrospective study at two centers in The Netherlands. Patients with NOUR received a four-week tined lead test phase. Success was defined as a ≥50% reduction of clean intermittent catheterization frequency or postvoid residual. We analyzed possible predictors of success with multivariable logistic regression. Second, all patients received a questionnaire to assess efficacy, perceived health (Patient Global Impression of Improvement), and treatment satisfaction.
This study included 215 consecutive patients (82 men and 133 women) who underwent a tined lead test phase for the treatment of NOUR. The success rate in women was significantly higher than in men, respectively 62% (83/133) and 22% (18/82, p < 0.001). In women, age per ten years (odds ratio [OR] 0.74, 95% CI: 0.59-0.93) and a history of psychiatric illness (OR 3.92, 95% CI: 1.51-10.2), including posttraumatic stress disorder (PTSD), significantly predicted first stage sacral neuromodulation (SNM) success. In men, age per ten years (OR 0.43, 95% CI: 0.25-0.72) and previous transurethral resection of the prostate and/or bladder neck incision (OR 7.71, 95% CI: 1.43-41.5) were significant predictors of success. Conversely, inability to void during a urodynamic study (for women, OR 0.79, 95% CI: 0.35-1.78; for men, OR 3.06, 95% CI: 0.83-11.3) was not predictive of success. Of the patients with a successful first stage, 75% (76/101) responded to the questionnaire at a median follow-up of three years. Of these patients, 87% (66/76) continued to use their SNM system, and 92% (70/76) would recommend SNM to other patients.
A history of psychiatric illness, including PTSD, in women with NOUR increased the odds of first stage SNM success 3.92 times. A previous transurethral resection of the prostate and/or bladder neck incision in men increased the odds of success 7.71 times. In addition, a ten-year age increase was associated with an OR of 0.43 in men and 0.74 in women, indicating a 2.3- and 1.3-times decreased odds of success, respectively.
本研究的目的是：1）确定非梗阻性尿潴留（NOUR）患者经皮穿刺电极测试阶段的成功率；2）确定NOUR患者测试阶段成功的预测因素；3）确定NOUR患者的长期治疗效果和满意度。
第一部分是在荷兰两个中心进行的多中心回顾性研究。NOUR患者接受为期四周的经皮穿刺电极测试阶段。成功定义为清洁间歇性导尿频率或残余尿量减少≥50%。我们使用多变量逻辑回归分析成功的可能预测因素。其次，所有患者均接受问卷调查，以评估疗效、感知健康状况（患者总体改善印象）和治疗满意度。
本研究纳入了215例连续接受经皮穿刺电极测试阶段治疗NOUR的患者（82例男性和133例女性）。女性的成功率显著高于男性，分别为62%（83/133）和22%（18/82，p<0.001）。在女性中，每增加十岁（优势比[OR]0.74，95%置信区间：0.59 - 0.93）以及有精神疾病史（OR 3.92，95%置信区间：1.51 - 10.2），包括创伤后应激障碍（PTSD），显著预测了第一阶段骶神经调节（SNM）的成功。在男性中，每增加十岁（OR 0.43，95%置信区间：0.25 - 0.72）以及既往经尿道前列腺切除术和/或膀胱颈切开术（OR 7.71，95%置信区间：1.43 - 41.5）是成功的显著预测因素。相反，尿动力学检查时不能排尿（女性，OR 0.79，95%置信区间：0.35 - 1.78；男性，OR 3.06，95%置信区间：0.83 - 11.3）不能预测成功。在第一阶段成功的患者中，75%（76/101）在中位随访三年时回复了问卷。在这些患者中，87%（66/76）继续使用他们的SNM系统，92%（70/76）会向其他患者推荐SNM。
NOUR女性患者有精神疾病史，包括PTSD，使第一阶段SNM成功的几率增加3.92倍。男性既往经尿道前列腺切除术和/或膀胱颈切开术使成功几率增加7.71倍。此外，年龄每增加十岁，男性的OR为0.43，女性为0.74，分别表明成功几率降低2.3倍和1.3倍。
