Abstract：
OBJECTIVE: The objective was to examine the outcomes of posterior tibial nerve stimulation (PTNS) on bladder, bowel, and sexual health-related quality of life among a cohort of patients with multiple sclerosis (MS) with refractory lower urinary tract symptoms (LUTS).
METHODS: Patients with MS and refractory LUTS were recruited for a prospective, observational study using PTNS to treat their symptoms. Patients underwent 12 weekly 30-min PTNS sessions and bladder, bowel, and sexual symptoms were evaluated at baseline, 3, 12, and 24 months with voiding diaries, visual analog scales (VAS), and validated patient-reported questionnaires, including the American Urological Association Symptom Score (AUA-SS), Neurogenic Bladder Symptom Score (NBSS), Michigan Incontinence Symptom Index (M-ISI), Health Status Questionnaire, Sexual Satisfaction Scale, and Bowel Control Scale.
RESULTS: A total of 23 patients were recruited: 18 started PTNS and 14 completed 3 months of PTNS. Of the 18 who started PTNS, the mean age was 52 years (SD 12), 61% were female, 83% were white, and most patients had relapsing remitting (39%) MS. Baseline (n=18) and 3-month voiding (n=11) outcomes showed no significant change in number of voids or incontinence episodes. The median VAS symptom improvement was 49 (IQR 26.5, 26) and 9 (53%) patients elected for monthly maintenance PTNS. On paired analysis, there was a significant improvement in median change in NBSS, AUA-SS, and M-ISI. There was no significant change in bowel or sexual dysfunction.
CONCLUSIONS: This prospective, observational study of PTNS in patients with MS with refractory LUTS shows improvement in patient-reported bladder outcomes, but not in number of voids per day or bowel or bladder function.
METHODS: Patients with MS and refractory LUTS were recruited for a prospective, observational study using PTNS to treat their symptoms. Patients underwent 12 weekly 30-min PTNS sessions and bladder, bowel, and sexual symptoms were evaluated at baseline, 3, 12, and 24 months with voiding diaries, visual analog scales (VAS), and validated patient-reported questionnaires, including the American Urological Association Symptom Score (AUA-SS), Neurogenic Bladder Symptom Score (NBSS), Michigan Incontinence Symptom Index (M-ISI), Health Status Questionnaire, Sexual Satisfaction Scale, and Bowel Control Scale.
RESULTS: A total of 23 patients were recruited: 18 started PTNS and 14 completed 3 months of PTNS. Of the 18 who started PTNS, the mean age was 52 years (SD 12), 61% were female, 83% were white, and most patients had relapsing remitting (39%) MS. Baseline (n=18) and 3-month voiding (n=11) outcomes showed no significant change in number of voids or incontinence episodes. The median VAS symptom improvement was 49 (IQR 26.5, 26) and 9 (53%) patients elected for monthly maintenance PTNS. On paired analysis, there was a significant improvement in median change in NBSS, AUA-SS, and M-ISI. There was no significant change in bowel or sexual dysfunction.
CONCLUSIONS: This prospective, observational study of PTNS in patients with MS with refractory LUTS shows improvement in patient-reported bladder outcomes, but not in number of voids per day or bowel or bladder function.
摘要：
目的：目的是检查胫骨后神经刺激（PTNS）对膀胱，肠,在一组患有难治性下尿路症状（LUTS）的多发性硬化症（MS）患者中，与性健康相关的生活质量。
方法：招募MS和难治性LUTS患者进行前瞻性，使用PTNS治疗其症状的观察性研究。患者接受12周30分钟PTNS治疗和膀胱，肠,性症状在基线时进行评估，3、12和24个月的日记，视觉模拟量表(VAS),并验证了患者报告的问卷，包括美国泌尿外科协会症状评分(AUA-SS)，神经源性膀胱症状评分（BSS），密歇根尿失禁症状指数（M-ISI）健康状况问卷，性满意度量表,和肠道控制量表。
结果：共招募23例患者：18例开始PTNS，14例完成3个月的PTNS。在开始PTNS的18人中，平均年龄为52岁（SD12），61%是女性，83%是白色的，大多数患者复发缓解（39%）MS。基线（n=18）和3个月排尿（n=11）结果显示，排尿或失禁发作的数量没有显着变化。中位VAS症状改善为49（IQR26.5，26）和9（53％）患者选择每月维持PTNS。在配对分析中，BSS的中位数变化显着改善，AUA-SS,还有M-ISI.肠道或性功能障碍无明显变化。
结论：这种前瞻性，PTNS在MS伴难治性LUTS患者中的观察性研究显示，患者报告的膀胱结局有所改善，但不是每天的空隙数量或肠或膀胱功能。
方法：招募MS和难治性LUTS患者进行前瞻性，使用PTNS治疗其症状的观察性研究。患者接受12周30分钟PTNS治疗和膀胱，肠,性症状在基线时进行评估，3、12和24个月的日记，视觉模拟量表(VAS),并验证了患者报告的问卷，包括美国泌尿外科协会症状评分(AUA-SS)，神经源性膀胱症状评分（BSS），密歇根尿失禁症状指数（M-ISI）健康状况问卷，性满意度量表,和肠道控制量表。
结果：共招募23例患者：18例开始PTNS，14例完成3个月的PTNS。在开始PTNS的18人中，平均年龄为52岁（SD12），61%是女性，83%是白色的，大多数患者复发缓解（39%）MS。基线（n=18）和3个月排尿（n=11）结果显示，排尿或失禁发作的数量没有显着变化。中位VAS症状改善为49（IQR26.5，26）和9（53％）患者选择每月维持PTNS。在配对分析中，BSS的中位数变化显着改善，AUA-SS,还有M-ISI.肠道或性功能障碍无明显变化。
结论：这种前瞻性，PTNS在MS伴难治性LUTS患者中的观察性研究显示，患者报告的膀胱结局有所改善，但不是每天的空隙数量或肠或膀胱功能。
