Zhu Wen, Shan Shuaishuai, Zhang Guoxian, Zhang Qinyong, Zhang Jing, Che Yingyu, Wen Jianguo, Wang Qingwei
Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Neuromodulation. 2023 Dec;26(8):1836-1844. doi: 10.1016/j.neurom.2022.07.002. Epub 2022 Aug 14.
In patients with detrusor overactivity with impaired contractility (DOIC), it is difficult to relieve abnormal lower urinary tract symptoms during both storage and voiding using sacral neuromodulation (SNM) with constant frequency stimulation (CFS). We sought to evaluate the efficacy and safety of SNM using variable frequency stimulation (VFS) in patients with DOIC by comparing it with outcomes of SNM with CFS.
Between September 2020 and May 2021, we prospectively enrolled 20 patients with DOIC, confirmed on urodynamic examination, and administered SNM with VFS. The patients were followed up and required to maintain voiding diaries and record scale scores of overactive bladder symptoms, psychology and quality of life, uroflowmetry, ultrasonic postvoid residual urine, and adverse events at baseline and during the CFS and VFS phases.
The average testing phase was 26.3 ± 4.1 days. Compared with baseline values, overactive bladder symptom, psychologic health questionnaire, and quality of life scores, in addition to voiding frequency, urgency incontinence frequency, daily catheterization volume of voiding diary, and ultrasonic postvoid residual (PVR) decreased significantly during both the CFS and VFS phases (p < 0.05). The average voided volume, functional bladder capacity, and maximum urine flow rate significantly increased during the CFS and VFS phases (p < 0.05). In the VFS phase, voiding frequency, urgency incontinence frequency, daily catheterization volume of voiding diary, and ultrasonic PVR further decreased (p < 0.05), whereas functional bladder capacity, maximum urine flow rate, quality of life score, overactive bladder symptom score, and psychologic health questionnaire score further improved compared with results obtained in the CFS phase (p < 0.05). In the VFS phase, the success rate of further improvement of symptoms was 85.0%, and no new complications were noted.
SNM that converts CFS into VFS may be an effective treatment option for patients with DOIC, exhibiting no increase in adverse events.
在逼尿肌过度活动伴收缩功能受损（DOIC）的患者中，使用恒定频率刺激（CFS）的骶神经调节（SNM）难以缓解储尿期和排尿期异常的下尿路症状。我们试图通过将其与CFS的SNM结果进行比较，评估使用可变频率刺激（VFS）的SNM对DOIC患者的疗效和安全性。
在2020年9月至2021年5月期间，我们前瞻性纳入了20例经尿动力学检查确诊为DOIC的患者，并给予VFS的SNM治疗。对患者进行随访，要求他们在基线以及CFS和VFS阶段记录排尿日记，并记录膀胱过度活动症状、心理和生活质量的量表评分、尿流率、超声测定的排尿后残余尿量以及不良事件。
平均测试阶段为26.3±4.1天。与基线值相比，在CFS和VFS阶段，膀胱过度活动症状、心理健康问卷和生活质量评分，以及排尿频率、急迫性尿失禁频率、排尿日记中的每日导尿量和超声测定的排尿后残余尿量（PVR）均显著降低（p<0.05）。在CFS和VFS阶段，平均排尿量、功能性膀胱容量和最大尿流率显著增加（p<0.05）。在VFS阶段，排尿频率、急迫性尿失禁频率、排尿日记中的每日导尿量和超声PVR进一步降低（p<0.05），而与CFS阶段的结果相比，功能性膀胱容量、最大尿流率、生活质量评分、膀胱过度活动症状评分和心理健康问卷评分进一步改善（p<0.05）。在VFS阶段，症状进一步改善的成功率为85.0%，未发现新的并发症。
将CFS转换为VFS的SNM可能是DOIC患者的一种有效治疗选择，且不良事件无增加。
