Jaworski Elaine Minerva, Sanderson Derrick J, Gevelinger Matthew, Doyle Paula J
School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
Curr Urol. 2024 Dec;18(4):318-322. doi: 10.1097/CU9.0000000000000101. Epub 2024 Dec 20.
Sacral neuromodulation (SNM) treatment of refractory urinary symptoms is associated with quality of life improvements using disease-specific instruments. There is a paucity of information relating universal health outcomes to effective treatment of urinary symptoms. The objective was to analyze changes in Patient-Reported Outcomes Measurement Information System (PROMIS) item-bank scores following SNM for treating refractory lower urinary tract symptoms (LUTS).
This is a sub-analysis collected from an institutional review board approved, retrospective chart review evaluating changes between pre- and post-procedure PROMIS scores in subjects undergoing successful SNM implantation for refractory LUTS at a multidisciplinary adult continence clinic. The difference between pre- and post-procedure PROMIS scores was compared via two-sided Wilcoxon signed-rank test, with .05 considered statistically significant.
Of the 29 subjects, most were female (89.66%), Caucasian (68.97%), nonsmokers (89.66%) with public insurance (62.07%). The median age was 63years and body mass index was 33.2kg/m. Procedure indications included urinary urge incontinence (83%), mixed urinary incontinence (10%), retention (17.24%), and overactive bladder (3%). Pain Interference and Depression scores had a nonsignificant improvement from 64.2 (ranging 58.9-67.5) to 60.75 (ranging 55.2-67.2), = 0.21, and 55.2 (ranging 51.5-59.9) to 53.4 (ranging 49.5-61.1), = 0.33, respectively. Median Physical Function scores demonstrated nonsignificant worsening following implantation from 38.0 (ranging 34.7-40.9) to 36.1 (ranging 33.1-40.8) = 0.25). Twenty-one subjects (72%) reported an improvement in at least 1 PROMIS item-bank with 6 subjects (21%) reporting no improvement in any of the item-banks.
Treatment of refractory LUTS with SNM resulted in no statistically significant changes in the PROMIS item-banks of Physical Function, Pain Interference, or Depression. Further prospective investigation is necessary to delineate the relationship of the self-reported universal-health outcomes in the treatment of LUTS.
使用特定疾病工具，骶神经调节（SNM）治疗难治性泌尿系统症状与生活质量改善相关。关于有效治疗泌尿系统症状与通用健康结局之间的信息匮乏。目的是分析采用SNM治疗难治性下尿路症状（LUTS）后患者报告结局测量信息系统（PROMIS）条目库评分的变化。
这是一项从机构审查委员会批准的回顾性病历审查中收集的亚分析，评估在一家多学科成人尿失禁诊所因难治性LUTS成功植入SNM的受试者术前和术后PROMIS评分的变化。术前和术后PROMIS评分的差异通过双侧Wilcoxon符号秩检验进行比较，P值<0.05被认为具有统计学意义。
29名受试者中，大多数为女性（89.66%）、白种人（68.97%）、非吸烟者（89.66%）且有公共保险（62.07%）。中位年龄为63岁，体重指数为33.2kg/m²。手术指征包括尿急失禁（83%）、混合性尿失禁（10%）、尿潴留（17.24%）和膀胱过度活动症（3%）。疼痛干扰和抑郁评分从64.2（范围为58.9 - 67.5）改善至60.75（范围为55.2 - 67.2），P = 0.21，以及从55.2（范围为51.5 - 59.9）改善至53.4（范围为49.5 - 61.1），P = 0.33，改善均无统计学意义。中位身体功能评分在植入后从38.0（范围为34.7 - 40.9）降至36.1（范围为33.1 - 40.8），P = 0.25，显示无统计学意义的恶化。21名受试者（72%）报告至少1个PROMIS条目库有改善，6名受试者（21%）报告任何条目库均无改善。
用SNM治疗难治性LUTS导致身体功能、疼痛干扰或抑郁的PROMIS条目库无统计学意义的变化。需要进一步的前瞻性研究来阐明LUTS治疗中自我报告的通用健康结局之间的关系。
