目的:为了介绍我们的经验,在伊拉克,难治性下尿路功能障碍患者的骶神经调节(SNM),讨论了影响应答率的因素。
方法:在此前瞻性中,临床,介入研究,由泌尿科医生和神经外科医生组成的团队对24名患者进行了为期1.5年的SNM评估和治疗。性别,年龄,病理学,和临床表现,都进行了研究和评估。成功的临床反应被定义为在排尿日记变量中达到≥50%的改善。
结果:对SNM做出反应的人的平均年龄为28岁,女性的反应比男性好(14人中有10人对10人中有4人)。根据介绍,膀胱过度活动症/急迫性尿失禁患者的SNM反应率为10分之6,九位尿潴留患者中有六位,五个人中有两个混合陈述。特发性排尿功能障碍的反应率为13个中的11个,而神经源性功能障碍的反应率为11个中的3个。其他好处,如排便,勃起功能,月经,下肢的力量,和生活质量(QoL),也被记录下来。这种微创手术的并发症是合理的。
结论:SNM为一些功能性膀胱问题提供了良好而持久的解决方案,如果患者选择良好。也可能有额外的尿外益处有助于改善QoL。我们的患者对SNM的耐受性良好,反应率令人鼓舞,特别是在特发性功能障碍的心理稳定患者中。
OBJECTIVE: To present our experience, in Iraq, with sacral neuromodulation (SNM) in patients with refractory lower urinary tract dysfunction, with discussion of the factors that affect the response rate.
METHODS: In this prospective, clinical, interventional study, 24 patients were evaluated and treated by a team comprised of a Urologist and a Neurosurgeon with SNM over a 1.5-year period. The gender, age, pathology, and clinical presentation, were all studied and evaluated. Successful clinical response was defined as achieving a ≥50% improvement in voiding diary variables.
RESULTS: The mean age of those that responded to SNM was 28 years, with females responding better than males (10 of 14 vs four of 10). The SNM response rate according to presentation was six of 10 in those with overactive bladder/urge urinary incontinence, six of nine of those with urinary retention, and two of five in those with a mixed presentation. The response rate in idiopathic voiding dysfunctions was 11 of 13, whilst for neurogenic dysfunctions it was three of 11. Other benefits such as in bowel motion, erectile function, menstruation, power of lower limbs, and quality of life (QoL), were also recorded. The complications were reasonable for this minimally invasive procedure.
CONCLUSIONS: SNM offers a good and durable solution for some functional bladder problems, if patients are well selected. There may also be additional extra-urinary benefits that contribute to improvements in QoL. SNM was well tolerated by our patients with an encouraging response rate, especially in psychologically stable patients with idiopathic dysfunctions.