骶神经调控术治疗男性特发性排尿困难的初步临床结果

Sacral neuromodulation preliminary outcomes in male patients with idiopathic dysuria

目的评估骶神经调控术(SNM)治疗男性特发性排尿困难的有效性和安全性。方法回顾性分析全国多个医学中心2012年1月至2016年12月收治的26例采用SNM治疗男性特发性排尿困难患者的临床资料。年龄19~86岁,平均45.2岁;临床表现为尿频、尿急、尿等待、尿不尽感、尿潴留等,可为其中一种或混合存在。所有患者均曾接受两项以上保守治疗方法(行为治疗、药物治疗等),但疗效不佳或无效。收集患者基线期、体验期及二期永久植入术后的排尿日记、尿急程度评分与生命质量(QoL)评分,并比较其差异。结果一期体验植入术后4例患者因对疗效不满意拒绝行二期永久植入术,22例接受二期永久植入术治疗,转化率为84.6%(22/26)。术后随访3~63个月,平均19.2个月。22例患者基线期日均残余尿量为[5(0,137.5)]ml、日均排尿次数为(14.6±6.1)次、次均尿量为[100(80,135)]ml。一期体验植入术后上述指标分别为[0(0,40)]ml、(9.1±2.8)次、[190(150,210)]ml,差异均有统计学意义(均P<0.05)。此外,在22例患者接受二期永久植入术后平均随访19.2个月时间内,可见残余尿量改善≥50%的人群占比从体验期时的55.6%提升至二期永久植入术后的80.0%,这提示残余尿量的改善与持续调控时间可能呈正相关。其余二期永久植入术后与体验期数据比较差异无统计学意义,未发生感染、电极移位断裂或其他不可逆的不良反应。结论SNM对保守治疗效果不佳的男性特发性排尿困难患者安全、有效,且疗效稳定,转化率高。此外,其持续调控时间可能与患者残余尿量的改善呈正相关。

Objective To assess the effectiveness and safety of sacral neuromodulation(SNM)therapy for men with idiopathic dysuria.Methods From January 2012 to December 2016,a total of 26 patients treated with SNM therapy from multi-center across the country were retrospectively studied.The age ranged from 19 to 86 years with an average age of 45.2 years.Patients suffered from one or multiple urinary symptoms such as frequency of urination,urgency,urinary retention,etc.All patients had received more than two types of conservative therapy including oral and behavioral therapy,but had poor or no improvement.The voiding diary,urgency score and the quality of life score before implantation,in stageⅠafter implantation and stageⅡafter permanent implantation were recorded and compared.Results A total of 22 patients chose to receive IPG at the end of stageⅠtherapy while 4 patients refused further stageⅡtherapy because of dissatisfactory effect.The conversion rate of stageⅠto stageⅡwas 84.6%(22/26).The average follow-up time was 19.2 months,ranging from 3 to 63 months.The baseline of residual urine,voiding frequency and average voiding amount and those after stageⅠtherapy were[5(0,137.5)]ml vs[0(0,40)]ml,14.6±6.1 vs 9.1±2.8,[100(80,135)]ml vs[190(150,210)]ml,respectively.The differences were statistically significant(all P<0.05).However,no significant differences were found in urination volume and quality of life(QoL)before and after implantation(P>0.05).During an average follow-up time of 19.2 months after the permanent implantation,over 80%patients had an improvement of residual urine volume by more than 50%after permanent implantation while the improvement was 55.6%after stageⅠtherapy,suggesting that the improvement of residual urine volume might be positively correlated with the duration of regulation.No significant differences were found in other parameters between stageⅠandⅡtherapy.No adverse events like wound infection and electrode dislocation happened during our study.Conclusions SNM is an effective and safety procedure for male patients with idiopathic dysuria,with a relatively high transfer rate.The medium-term curative effect is stable.The duration of regulation may be positively correlated with the improvement of residual urine.