目的:膀胱过度活动症(OAB)影响全球数百万患者。它的治疗具有挑战性,但可以改善患者的生活质量。除了神经调节的标准技术(骶和阴部神经调节和胫后神经刺激),已经研究了几种新技术来治疗难治性OAB的症状。本综述的目的是概述用于下尿路功能障碍(LUTD)的新神经调节技术的最新技术。
方法:2023年3月,一份全面的MEDLINE,EMBASE,并进行了Scopus搜索(关键词:LUTD,新技术,神经调节,LUTS,OAB,膀胱疼痛综合征,etc).根据纳入情况纳入文章(随机对照试验,前瞻性试验,大型回顾性研究)和排除(病例报告,全文没有明确表达的结果,动物研究)标准。还扫描了纳入研究的参考列表。包括成人和儿童人群,除了神经源性和非神经源性OAB。然后进行了叙述性审查。
结果:腓骨神经调节,经皮神经电刺激,磁神经刺激,和骶骨旁经皮神经调节是研究最多的研究技术,并被证明在治疗OAB症状方面取得了有希望的结果。即使在OAB患者难以接受标准治疗的复杂情况下,大多数研究也显示出有希望的结果。将研究技术与护理标准及其各自的临床结果和安全性进行比较,面对他们的利弊,我们有理由相信,一旦这种治疗方式得到进一步发展,它们可以在OAB治疗算法中发挥作用。
结论:尽管所描述的神经调节技术正在被深入研究,现有结果尚不足以推荐其使用的任何指南。
OBJECTIVE: Overactive bladder (OAB) affects millions of patients worldwide. Its treatment is challenging but improves the patient\'s quality of life. Besides standard techniques for neuromodulation (sacral and pudendal neuromodulation and posterior tibial nerve stimulation), several new techniques have been investigated to treat symptoms of refractory OAB. The purpose of the present
review is to outline the state of the art of new neuromodulation techniques for lower urinary tract dysfunction (LUTD).
METHODS: In March 2023, a comprehensive MEDLINE, EMBASE, and Scopus search was carried out (keywords: LUTD, new technologies, neuromodulation, LUTS, OAB, painful bladder syndromes, etc). Articles were included according to inclusion (randomized controlled trials, prospective trials, large retrospective studies) and exclusion (case reports, outcomes not clearly expressed in full text, animal studies) criteria. The reference lists of the included studies also were scanned. Both adult and pediatric populations were included, in addition to both neurogenic and nonneurogenic OAB. A narrative
review was then performed.
RESULTS: Peroneal neuromodulation, transcutaneous electrical nerve stimulation, magnetic nerve stimulation, and parasacral transcutaneous neuromodulation are the most studied investigative techniques and were shown to yield promising results in treating OAB symptoms. Most studies showed promising results even in the complex scenarios of patients with OAB refractory to standard treatments. Comparing investigational techniques with standard of care and their respective clinical outcomes and safety profiles, and confronting their pros and cons, we reasonably believe that once such treatment modalities are further developed, they could play a role in the OAB treatment algorithm.
CONCLUSIONS: Although the described neuromodulation techniques are being intensely studied, the available results are not yet sufficient for any guidelines to recommend their use.