骶神经调节术治疗膀胱逼尿肌无力的疗效分析

Therapeutic effects of sacral neuromodulation on detrusor underactivity

目的:评估骶神经调节术(sacral neuromodulation,SNM)治疗膀胱逼尿肌无力的有效性。方法:回顾性分析2019年11月至2020年4月采用SNM治疗的6例膀胱逼尿肌无力患者的临床资料,患者年龄46~65岁,平均58岁,男性3例,女性3例。所有患者术前均行尿动力学检查明确膀胱逼尿肌无力的诊断,膀胱镜检查明确是否存在膀胱出口梗阻。患者术前均留置膀胱造瘘管,24 h平均排尿次数为23.8次(18~33次),平均每次尿量为34.2 mL(10~50 mL),平均每次残余尿量为421.7 mL(350~520 mL)。比较手术前后患者24 h的排尿次数、平均每次尿量以及残余尿量的变化情况。结果:6例患者均接受Ⅰ期SNM治疗,Ⅰ期手术时间平均为90 min(62~135 min),Ⅰ期电极植入后测试时间平均为2周(1~3周)。有4例患者转为Ⅱ期手术,转换率为66.7%(4/6)。Ⅰ期电极植入后,6例患者的24 h平均排尿次数为13.5次(9~18次),平均每次尿量为192.5 mL(150~255 mL),平均每次残余尿量为97.5 mL(60~145 mL),与Ⅰ期电极植入前相比差异均有统计学意义(P<0.001)。Ⅱ期术后患者随访10~15个月,平均11.3个月,均未出现切口感染、血肿、电极排异反应、电极移位等严重不良反应。截至随访结束,4例行Ⅱ期手术的患者中有1例需要行间歇导尿治疗,每日间歇导尿1次,其余3例无需间歇导尿。结论:SNM可显著改善膀胱逼尿肌无力患者的排尿症状,减少残余尿量,是安全、有效的微创治疗手段。

Objective:To evaluate the effects of sacral neuromodulation(SNM)on detrusor underactivity(DUA).Methods:From December 2019 to April 2020,6 patients with DUA who had been treated with SNM were assessed retrospectively.The average age was 58 years(46-65 years),with 3 males and 3 females.All the patients were diagnosed with DUA by urodynamics examination.Obstruction of bladder outlet was excluded through the cystoscopy.No patient had the history of neurological disease.All the patients were placed with the bladder colostomy tube before SNM.One female patient accepted the trans-urethral resection of bladder neck.Two male patients accepted the trans-urethral resection of prostate.All the 3 patients had no improvement of void symptom after the urethral operation.Before SNM,the average 24 h times of voiding was 23.8(18-33),average volume of every voiding was 34.2 mL(10-50 mL),average residual volume was 421.7 mL(350-520 mL).The preoperative and postoperative 24 h urine frequency,average voided volume,and average residual urine volume were compared respectively.Results:Totally 6 patients underwent SNM with stageⅠprocedure.The operation time for stageⅠprocedure was 62-135 min(average 90 min).After an average follow-up of two weeks,stageⅡprocedure was performed on responders.Four patients accepted stageⅡprocedure(conversion rate 66.7%),the other two patients refused the stageⅡprocedure because the urine frequency did not reach the satisfied level.But all the patients had the improvement of residual urine volume.For the 4 patients at the follow-up of 10-15 months,the improvement of void was still obvious.For the all patients after stageⅠprocedure,the average 24 h urine frequency reduced to 13.5 times(9-18 times,P<0.001),the average voided volume increased to 192.5 mL(150-255 mL,P<0.001),and the average residual urine volume reduced to 97.5 mL(60-145 mL,P<0.001).No adverse events,such as wound infection or electrode translocation were detected during an average follow-up of 11.3 months.Only one of the 4 patients who received the stageⅡprocedure did the intermittent catheterization for one time each day.Conclusion:SNM provides a minimal invasive approach for the management of DUA.