Lee Eugene W, Lee Una J, Lucioni Alvaro, Kobashi Kathleen C
Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington.
Urol Pract. 2015 Jan;2(1):22-25. doi: 10.1016/j.urpr.2014.08.004. Epub 2014 Oct 27.
Elderly women have a high incidence of refractory overactive bladder. Clinicians and elderly patients may be hesitant to consider sacral neuromodulation. We investigated outcomes of sacral neuromodulation in women 80 years old or older.
From 2000 to 2013, 24 octogenarians with overactive bladder underwent stage 1 implantation of the InterStim® sacral neuromodulation device. We defined stage 1 success as 50% or greater improvement in incontinence episodes and/or pads. Those patients underwent placement of an implantable pulse generator. The primary study outcome was the rate of stage 1 success. Secondary outcomes were the complication rate and patient reported improvement/satisfaction.
We identified 24 octogenarians with a median age of 85 years (range 80 to 89), of whom 18 (75%) experienced stage 1 success. At a mean 17-month followup (range 1 to 59) success was sustained in 13 patients (72%) and 15 (83%) were medication free. Two patients (12%) experienced complications, including urinary tract infection in 1 and pain at the implantable pulse generator site in 1, which resolved within 1 month. Three patients (17%) underwent lead revision and 2 subsequently regained success. Five of the 10 patients (50%) who returned the PGI-I questionnaire reported that their condition was very much or much improved, 3 felt a little improved and 2 reported no change. The self-reported satisfaction rate was 60%.
Octogenarian women treated with sacral neuromodulation had a high rate of stage 1 success with no major complications. Most of them reported improvement and satisfaction at a mean followup of 17 months. Advanced age alone should not preclude consideration of sacral neuromodulation as a treatment option for overactive bladder in the properly selected elderly patient.
老年女性难治性膀胱过度活动症的发病率较高。临床医生和老年患者可能对考虑骶神经调节疗法有所犹豫。我们调查了80岁及以上女性骶神经调节的疗效。
2000年至2013年，24名患有膀胱过度活动症的八旬老人接受了InterStim®骶神经调节装置的一期植入。我们将一期手术成功定义为尿失禁发作次数和/或尿垫使用量改善50%或更多。这些患者接受了植入式脉冲发生器的植入。主要研究结果是一期手术成功率。次要结果是并发症发生率以及患者报告的改善情况/满意度。
我们确定了24名八旬老人，中位年龄为85岁（范围80至89岁），其中18名（75%）一期手术成功。平均随访17个月（范围1至59个月）时，13名患者（72%）维持成功状态，15名（83%）无需药物治疗。2名患者（12%）出现并发症，包括1例尿路感染和1例植入式脉冲发生器部位疼痛，均在1个月内缓解。3名患者（17%）进行了电极导线翻修，其中2名随后再次取得成功。在返回PGI-I问卷的10名患者中，5名（50%）报告其病情有很大或较大改善，3名感觉有一点改善，2名报告无变化。自我报告的满意率为60%。
接受骶神经调节治疗的八旬老年女性一期手术成功率较高，且无重大并发症。她们中的大多数人在平均17个月的随访中报告病情有所改善且感到满意。仅高龄本身不应排除在适当选择的老年患者中将骶神经调节作为膀胱过度活动症的一种治疗选择。
