Shaker H S, Hassouna M
Division of Urology, Toronto Hospital, University of Toronto, Ontario, Canada.
J Urol. 1998 May;159(5):1516-9. doi: 10.1097/00005392-199805000-00028.
Sacral foramina implants have been recognized recently as a method for treatment of refractory urinary urge incontinence. We study the outcome of the procedure with in-depth analysis of the results of 18 implanted cases.
Patients with urinary urge incontinence were subjected to percutaneous nerve evaluation of the S3 roots as a temporary screening test to determine response to neuromodulation. Satisfactory responders were implanted with permanent sacral root neuroprosthesis. The study design included comprehensive voiding diaries for 4 consecutive days twice as a baseline, 1 with percutaneous nerve evaluation screening, 1 after the percutaneous nerve evaluation, 1 at the 1, 3 and 6 post-implantation visits, and every 6 months thereafter. Uroflowmetry and quality of life questionnaires were performed at the same intervals. Urodynamic study was done as a baseline and 6 months after implantation of the neuroprosthesis.
All 18 patients (16 women and 2 men) with refractory urge incontinence received a sacral foramina neuroprosthesis after demonstrating a good response to the percutaneous nerve evaluation. Average patient age at presentation was 42.3+/-3.3 years (range 22 to 67) and duration of urinary symptoms was 6.6+/-1.3 years (range 1.2 to 18.8). Average followup was 18.8 months (range 3 to 83). Neuromodulation in these patients showed a marked reduction in leakage episodes from 6.49 to 1.98 times per 24 hours and in the leakage severity score. Eight patients became completely dry and 4 had average leakage episodes of 1 or less daily. Patients showed as well a decrease in urinary frequency with an increase in functional bladder capacity. Associated pelvic pain improved substantially. Cystometrograms demonstrated increased volume at first sensation by 50% and increased cystometric capacity by 15% with the disappearance of uninhibited contractions in 1 of the 4 patients who presented with it preoperatively. There was also noticeable improvement in the quality of life. Complication rate was low and none was life threatening.
Sacral root neuromodulation is an appealing modality for treatment of urge incontinence refractory to conventional pharmacotherapy. The relative simplicity of the technique, promising results and low complication rate make this therapy a likely alternative.
骶孔植入物最近已被公认为是一种治疗难治性尿急失禁的方法。我们通过对18例植入病例的结果进行深入分析来研究该手术的疗效。
对尿急失禁患者进行S3神经根的经皮神经评估，作为一种临时筛查试验，以确定对神经调节的反应。反应良好者植入永久性骶神经根神经假体。研究设计包括连续4天两次的综合排尿日记，一次作为基线，一次在经皮神经评估筛查时，一次在经皮神经评估后，一次在植入后1个月、3个月和6个月的随访时，此后每6个月一次。在相同间隔时间进行尿流率测定和生活质量问卷调查。在基线时和神经假体植入后6个月进行尿动力学研究。
所有18例（16例女性和2例男性）难治性尿急失禁患者在对经皮神经评估显示出良好反应后均接受了骶孔神经假体植入。患者就诊时的平均年龄为42.3±3.3岁（范围22至67岁），尿路症状持续时间为6.6±1.3年（范围1.2至18.8年）。平均随访时间为18.8个月（范围3至83个月）。这些患者的神经调节显示漏尿次数从每24小时6.49次显著减少至1.98次，漏尿严重程度评分也降低。8例患者完全无漏尿，4例患者平均每日漏尿次数为1次或更少。患者的尿频也有所减少，功能性膀胱容量增加。相关的盆腔疼痛有显著改善。膀胱测压图显示，术前有此表现的4例患者中有1例首次有感觉时的容量增加了50%，膀胱测压容量增加了15%，无抑制性收缩消失。生活质量也有明显改善。并发症发生率低，无一例危及生命。
骶神经根神经调节是治疗对传统药物治疗无效的尿急失禁的一种有吸引力的方式。该技术相对简单、结果 promising且并发症发生率低，使这种治疗成为一种可能的选择。 （注：原文中“promising results”直译为“有希望的结果”，意译为“前景良好的结果”更通顺，但要求不添加其他解释，所以保留原文表述。）
