骶神经调控术治疗老年人排尿困难的疗效分析

Analysis of efficiency of sacral neuromodulation in the treatment of non-neurogenic and non-obstructive dysuria in elderly patients

目的评估骶神经调控术(sacral neuromodulation,SNM)治疗老年人非神经源性、非机械梗阻性排尿困难的有效性和安全性。方法统计全国多个医学中心自2012年1月至2016年12月收治的共6例(男2例、女4例)因非神经源性、非机械梗阻排尿困难行SNM治疗的老年患者临床资料,并对其进行回顾性分析。所有患者均曾接受两种以上保守治疗方法(物理疗法、药物治疗等)或手术治疗,但疗效不佳或无效。收集患者基线期、体验期及永久性调节器植入术后(末次随访时)的日均残余尿量及次尿量、最大次尿量、日均排尿次数与生命质量评分(QOL),并比较其差异。结果6例患者年龄65~79岁,平均(69.5±5.6)岁,骶神经调节的结果显示,其重要客观症状和/或主观指标均改善50%以上,较术前明显好转。6例患者均接受SNM永久植入,转化率为100.0%,其永久植入后疗效稳定。6例患者日均残余尿量在基线期、体验期及末次随访时的平均值分别为(161.7±110.2)ml、(70.0±52.2)ml、(50.0±44.7)ml;日均次尿量的平均值分别为(105.0±74.0)ml、(163.3±93.1)ml、(155.0±92.3)ml;最大次尿量的平均值分别为(146.7±81.2)ml、(216.7±93.1)ml、(206.7±112.7)ml,患者症状改善明确。随访时间为7~57个月,平均17.5个月,未出现切口感染、电极移位、血肿等严重不良反应。结论SNM对其他治疗效果不佳的非神经源性、非机械梗阻性排尿困难的老年患者安全、有效,中期疗效稳定,Ⅰ期至Ⅱ期转化率较高,是较好的手术适应证,其持续调控时间可能与患者残余尿及排尿次数的改善呈正相关。

Objective To evaluate the effectiveness and safety of sacral neuromodulation(SNM)in the treatment of non-neurogenic and non-obstructive dysuria in elderly patients.Methods Six elderly patients with non-neurogenic and non-obstructive(2 males and 4 females)treated with SNM were recruited from multiple medical centers across the country in this retrospective study from January 2012 to December 2016.All patients received two or more conservative treatments including behavior therapy,oral therapy,etc.,with no good effect.Data of the average residual urine volume,average urine volume,maximum urine volume,average urinary frequency and quality of life score before operation,after implantation of stageⅠtined lead,and at the end of follow-up after implantation of stageⅡimplanted pulse generator(IPG)were compared.Results The average age in the 6 patients was 69.5(65~79)years.The results of SNM treatment showed that the objective findings and/or subjective symptoms in all patients were significantly improved in more than 50%of indexes before treatment.All patients chose embedding of IPG at the end of stageⅠ,with 100.0%of the conversion rate from stageⅠto stageⅡ.The curative effect was stable in general.At stages of baseline,personal experience and end of follow-up respectively,the average residual urine volumes were(161.7±110.2)ml,(70.0±52.2)ml,and(50.0±44.7)ml,the average urine volume were(105.0±74.0)ml,(163.3±93.1)ml,and(155.0±92.3)ml,and the maximum urine volume were(146.7±81.2)ml,(216.7±93.1)ml,and(206.7±112.7)ml,which showed continuously significant improvements with patients'great satisfaction.The mean duration of fellow-up in 6 cases was 17.5 months(7-57 months).No severe adverse reactions such as wound infection,electrode dislocation and hematoma were observed.Conclusions SNM treatment is safe and effective for elderly patients with non-neurogenic and non-obstructive dysuria who are refractory to other treatments.SNM has a stable medium-term curative effect and a high-transfer-rate from stageⅠto stageⅡ,which is appropriate for non-neurogenic and non-obstructive dysuria.The duration of SNM may be positively correlated with the improvement of residual urine volume and urination frequency.