骶神经调控术变频刺激模式治疗难治性下尿路功能障碍疾病的疗效和安全性

Efficacy and safety of sacral neuromodulation variable-frequency stimulation in the treatment of refractory lower urinary tract dysfunction

本研究前瞻性收集2020年6—12月北京医院和郑州大学第一附属医院接受骶神经调控术变频刺激(VFS)模式治疗患者的临床资料,探讨VFS模式治疗难治性下尿路功能障碍的疗效和安全性。纳入标准:①已植入骶神经刺激系统;②年龄≥18岁;③传统恒频刺激骶神经调控术(CFS-SNM)治疗效果不佳,经反复调整刺激参数仍无法获得满意改善;④存在膀胱过度活动症(OAB)症状,保守治疗无效或不耐受保守治疗的患者;⑤试验期间不随意增减影响下尿路症状及盆腔功能的相关药物;⑥自愿参加且签署知情同意书。共6例患者纳入研究,男女各3例。平均年龄55(47~74)岁。3例诊断为OAB,2例诊断为间质性膀胱炎(IC),1例诊断为神经源性膀胱。所有患者升级为VFS模式前接受CFS治疗时间平均20.6个月,均伴有缓解不满意的严重尿频症状。治疗结果显示,4例在恒频期和变频期的日均排尿次数分别为14次和12次,11次和8次,11次和8次,16次和9次;膀胱过度活动症调查问卷(OAB-Q)评分分别为7分和4分,6分和6分,2.5分和2分,4分和3分,均呈改善趋势。2例IC患者在变频期的尿频症状较前加重,但疼痛视觉模拟评分(VAS)未见明显变化,其中1例在恒频期和变频期的VAS均为6分,1例分别为7分和5分。总体来说,VFS模式对尿频症状的改善程度不劣于CFS模式。对于IC患者,可在获得满意的疼痛管理前提下尝试多组变频参数。

This study prospectively collected the clinical data of patients who received sacral neuromodulation(SNM)variable-frequency stimulation(VFS)mode from June 2020 to December 2020,in order to explore the efficacy and safety of VFS mode in the treatment of refractory lower urinary tract dysfunction.The inclusion criteria were as follows:①SNM was implanted;②age≥18 years old;③The traditional constant-frequency stimulation(CFS)mode has poor therapeutic effect,and can not be improved after repeated adjustment of stimulation parameters;④Patients with overactive bladder(OAB)symptoms,who fail to respond to conservative treatment or are intolerant to conservative treatment;⑤The drugs that affect the lower urinary tract symptoms and pelvic function should not be increased or decreased during the trial;⑥provision of informed consent.A total of six patients meeting the criteria were included in the study,with three males and three females.The age ranged from 47 to 74 years,with an average age of 55 years.Among those patients,three cases were diagnosed of OAB,two cases were diagnosed of interstitial cystitis,and one case was diagnosed of neurogenic bladder.All patients had received CFS-SNM for an average of 20.6 months before upgrading to VFS mode,and suffered from severe frequency of urination at the same time.Compared with the severity of symptoms during the baseline period and the CFS period,a trend of improvement was found among four patients during the VFS period.The severity of symptoms was mainly based on the average daily urination frequency and OAB-Q score.For the two patients with interstitial cystitis,OAB symptoms worsened during the VFS period,while the VAS score did not change significantly.In general,VFS-SNM is not inferior to CFS-SNM in improving the symptoms of frequent micturition.For patients with interstitial cystitis,multiple sets of VFS parameters can be tried under the premise of satisfactory pain management.