BACKGROUND Management of non-neurogenic,non-obstructive dysuria represents one of the most challenging dilemmas in urological practice.The main clinical symptom is the increase in residual urine.Voiding dysfunction is...BACKGROUND Management of non-neurogenic,non-obstructive dysuria represents one of the most challenging dilemmas in urological practice.The main clinical symptom is the increase in residual urine.Voiding dysfunction is the main cause of dysuria or urinary retention,mainly due to the decrease in bladder contraction(the decrease in contraction amplitude or duration)or the increase in outflow tract resistance.Sacral neuromodulation(SNM)has been used for>10 years to treat many kinds of lower urinary tract dysfunction.It has become increasingly popular in China in recent years.Consequently,studies focusing on nonneurogenic,non-obstructive dysuria patients treated by SNM are highly desirable.AIM To assess the outcome of two-stage SNM in non-neurogenic,non-obstructive dysuria.METHODS Clinical data of 54 patients(26 men,28 women)with non-neurogenic,nonobstructive dysuria treated by SNM from January 2012 to December 2016 in ten medical centers in China were retrospectively analyzed.All patients received two or more conservative treatments.The voiding diary,urgency score,and quality of life score before operation,after implantation of tined lead in stage I(test period),and during short-term follow-up(latest follow-up)after implantation of the implanted pulse generator in stage II were compared to observe symptom improvements.RESULTS Among the 54 study patients,eight refused to implant an implanted pulse generator because of the unsatisfactory effect,and 46 chose to embed the implanted pulse generator at the end of stage I.The conversion rate of stage I to stage II was 85.2%.The average follow-up time was 18.6 mo.There were significant differences between baseline(before stage I)and the test period(after stage I)in residual urine,voiding frequency,average voiding amount,maximum voiding amount,nocturia,urgency score,and quality of life score.The residual urine and urgency score between the test period and the latest follow-up time(after stage II)were also significantly different.No significant differences were observed for other parameters.No wound infection,electrode breakage,or other irreversible adverse events occurred.CONCLUSION SNM is effective for patients with non-neurogenic,non-obstructive dysuria showing a poor response to traditional treatment.The duration of continuous stimulation may be positively correlated with the improvement of residual urine.展开更多
BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of life.Many modalities of treatment exist for FI.Sacral nerve stimulation is a we...BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of life.Many modalities of treatment exist for FI.Sacral nerve stimulation is a well-established treatment for FI.Given the increased need of magnetic resonance imaging(MRI)for diagnostics,the In-terStim which was previously used in sacral nerve stimulation was limited by MRI incompatibility.Medtronic MRI-compatible InterStim was approved by the United States Food and Drug Administration in August 2020 and has been widely used.AIM To evaluate the efficacy,outcomes and complications of the MRI-compatible InterStim.METHODS Data of patients who underwent MRI-compatible Medtronic InterStim placement at UPMC Williamsport,University of Minnesota,Advocate Lutheran General Hospital,and University of Wisconsin-Madison was pooled and analyzed.Patient demographics,clinical features,surgical techniques,complications,and outcomes were analyzed.Strengthening the Reporting of Observational studies in Epidemiology(STROBE)cross-sectional reporting guidelines were used.RESULTS Seventy-three patients had the InterStim implanted.The mean age was 63.29±12.2 years.Fifty-seven(78.1%)patients were females and forty-two(57.5%)patients had diabetes.In addition to incontinence,overlapping symptoms included diarrhea(23.3%),fecal urgency(58.9%),and urinary incontinence(28.8%).Fifteen(20.5%)patients underwent Peripheral Nerve Evaluation before proceeding to definite implant placement.Thirty-two(43.8%)patients underwent rechargeable InterStim placement.Three(4.1%)patients needed removal of the implant.Migration of the external lead connection was observed in 7(9.6%)patients after the stage I procedure.The explanation for one patient was due to infection.Seven(9.6%)patients had other complications like nerve pain,hematoma,infection,lead fracture,and bleeding.The mean follow-up was 6.62±3.5 mo.Sixty-eight(93.2%)patients reported significant improvement of symptoms on follow-up evaluation.CONCLUSION This study shows promising results with significant symptom improvement,good efficacy and good patient outcomes with low complication rates while using MRI compatible InterStim for FI.Further long-term follow-up and future studies with a larger patient population is recommended.展开更多
Background： Sacral neuromodulation （SNM） has become an effective method for treating lower urinary tract voiding dysfunction during the past 20 years. Because of the expensive cost, the number of implantable pulse ...Background： Sacral neuromodulation （SNM） has become an effective method for treating lower urinary tract voiding dysfunction during the past 20 years. Because of the expensive cost, the number of implantable pulse generator （IPG） implantations per year in China is far lower than that in Western developed countries since 2012. This study was to summarize the effects of the appropriate prolonged SNM testing time in improving the implantation rate of a permanent IPG in patients with refractory lower urinary tract symptoms （LUTS） in China's Mainland. Methods： From January 2013 to June 2016, 51 patients with refractory LUTS received SNM therapy, in this study, we compared the conversion rate 2 weeks after the Stage I test and final actual conversion rate. We also observed the complications （such as pain, infection, and electrode displacement） and effectiveness. We tried to improve an appropriate prolonged test time which was favorable for improving the SNM conversion rate while ensuring safety and effectiveness. Results： Among 51 patients receiving SNM therapy, 19 patients （mean age 45.0 ±16.9 years） had poor Stage I test results, and on an average, the electrode was removed 27.4 ± 9.6 days after the surgery. In one patient, the electrode was removed within 2 weeks; when the remaining 18 patients were questioned 2 weeks after testing, none of the patients wanted to terminate the test, and all the 18 patients desired to prolong the testing time to further observe the treatment effect. The remaining 32 patients （mean age 46.7 ± 15.3 years） received Stage If permanent implantation at 19.6 ± 10.4 days after the surgery. The overall Stage Ⅰ-Ⅱ conversion was 62.7% （32/51） in this study. Within 2 weeks after the surgery, only eight patients received Stage II permanent implantation, and the conversion rate was only 15.7% （8/51 ）, which was much lower than the overall conversion rate of 62.7%. Nearly 84.4% （27/32） of the patients received Stage 11 implantation within 4 weeks. None of the patients had incision infections. In one patient, the entire system was removed 1 month after Stage II implantation due to pain in the implantation site. Conclusions： Appropriate extension of the Stage I testing time of an SNM-barbed electrode could significantly improve the Stage II permanent implantation rate in Chinese refractory LUTS patients; there were no wound infections, and the postoperative complication rate was low. This study recommended that Stage I period of SNM therapy should be 4 weeks according to safety and successful conversion rate.展开更多
Sacral neuromodulation(SNM)therapy has revolutionized the management of many forms of anal incontinence,with an expanded use and a medium-term efficacy of 75%overall.This review discusses the technique of SNM therapy,...Sacral neuromodulation(SNM)therapy has revolutionized the management of many forms of anal incontinence,with an expanded use and a medium-term efficacy of 75%overall.This review discusses the technique of SNM therapy,along with its complications and troubleshooting and a discussion of the early data pertaining to peripheral posterior tibial nerve stimulation in incontinent patients.Future work needs to define the predictive factors for neurostimulatory success,along with the likely mechanisms of action of their therapeutic action.展开更多
基金Supported by National Key Research and Development Program of China,No.2018YFC2002202.
文摘BACKGROUND Management of non-neurogenic,non-obstructive dysuria represents one of the most challenging dilemmas in urological practice.The main clinical symptom is the increase in residual urine.Voiding dysfunction is the main cause of dysuria or urinary retention,mainly due to the decrease in bladder contraction(the decrease in contraction amplitude or duration)or the increase in outflow tract resistance.Sacral neuromodulation(SNM)has been used for>10 years to treat many kinds of lower urinary tract dysfunction.It has become increasingly popular in China in recent years.Consequently,studies focusing on nonneurogenic,non-obstructive dysuria patients treated by SNM are highly desirable.AIM To assess the outcome of two-stage SNM in non-neurogenic,non-obstructive dysuria.METHODS Clinical data of 54 patients(26 men,28 women)with non-neurogenic,nonobstructive dysuria treated by SNM from January 2012 to December 2016 in ten medical centers in China were retrospectively analyzed.All patients received two or more conservative treatments.The voiding diary,urgency score,and quality of life score before operation,after implantation of tined lead in stage I(test period),and during short-term follow-up(latest follow-up)after implantation of the implanted pulse generator in stage II were compared to observe symptom improvements.RESULTS Among the 54 study patients,eight refused to implant an implanted pulse generator because of the unsatisfactory effect,and 46 chose to embed the implanted pulse generator at the end of stage I.The conversion rate of stage I to stage II was 85.2%.The average follow-up time was 18.6 mo.There were significant differences between baseline(before stage I)and the test period(after stage I)in residual urine,voiding frequency,average voiding amount,maximum voiding amount,nocturia,urgency score,and quality of life score.The residual urine and urgency score between the test period and the latest follow-up time(after stage II)were also significantly different.No significant differences were observed for other parameters.No wound infection,electrode breakage,or other irreversible adverse events occurred.CONCLUSION SNM is effective for patients with non-neurogenic,non-obstructive dysuria showing a poor response to traditional treatment.The duration of continuous stimulation may be positively correlated with the improvement of residual urine.
文摘BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of life.Many modalities of treatment exist for FI.Sacral nerve stimulation is a well-established treatment for FI.Given the increased need of magnetic resonance imaging(MRI)for diagnostics,the In-terStim which was previously used in sacral nerve stimulation was limited by MRI incompatibility.Medtronic MRI-compatible InterStim was approved by the United States Food and Drug Administration in August 2020 and has been widely used.AIM To evaluate the efficacy,outcomes and complications of the MRI-compatible InterStim.METHODS Data of patients who underwent MRI-compatible Medtronic InterStim placement at UPMC Williamsport,University of Minnesota,Advocate Lutheran General Hospital,and University of Wisconsin-Madison was pooled and analyzed.Patient demographics,clinical features,surgical techniques,complications,and outcomes were analyzed.Strengthening the Reporting of Observational studies in Epidemiology(STROBE)cross-sectional reporting guidelines were used.RESULTS Seventy-three patients had the InterStim implanted.The mean age was 63.29±12.2 years.Fifty-seven(78.1%)patients were females and forty-two(57.5%)patients had diabetes.In addition to incontinence,overlapping symptoms included diarrhea(23.3%),fecal urgency(58.9%),and urinary incontinence(28.8%).Fifteen(20.5%)patients underwent Peripheral Nerve Evaluation before proceeding to definite implant placement.Thirty-two(43.8%)patients underwent rechargeable InterStim placement.Three(4.1%)patients needed removal of the implant.Migration of the external lead connection was observed in 7(9.6%)patients after the stage I procedure.The explanation for one patient was due to infection.Seven(9.6%)patients had other complications like nerve pain,hematoma,infection,lead fracture,and bleeding.The mean follow-up was 6.62±3.5 mo.Sixty-eight(93.2%)patients reported significant improvement of symptoms on follow-up evaluation.CONCLUSION This study shows promising results with significant symptom improvement,good efficacy and good patient outcomes with low complication rates while using MRI compatible InterStim for FI.Further long-term follow-up and future studies with a larger patient population is recommended.
文摘Background： Sacral neuromodulation （SNM） has become an effective method for treating lower urinary tract voiding dysfunction during the past 20 years. Because of the expensive cost, the number of implantable pulse generator （IPG） implantations per year in China is far lower than that in Western developed countries since 2012. This study was to summarize the effects of the appropriate prolonged SNM testing time in improving the implantation rate of a permanent IPG in patients with refractory lower urinary tract symptoms （LUTS） in China's Mainland. Methods： From January 2013 to June 2016, 51 patients with refractory LUTS received SNM therapy, in this study, we compared the conversion rate 2 weeks after the Stage I test and final actual conversion rate. We also observed the complications （such as pain, infection, and electrode displacement） and effectiveness. We tried to improve an appropriate prolonged test time which was favorable for improving the SNM conversion rate while ensuring safety and effectiveness. Results： Among 51 patients receiving SNM therapy, 19 patients （mean age 45.0 ±16.9 years） had poor Stage I test results, and on an average, the electrode was removed 27.4 ± 9.6 days after the surgery. In one patient, the electrode was removed within 2 weeks; when the remaining 18 patients were questioned 2 weeks after testing, none of the patients wanted to terminate the test, and all the 18 patients desired to prolong the testing time to further observe the treatment effect. The remaining 32 patients （mean age 46.7 ± 15.3 years） received Stage If permanent implantation at 19.6 ± 10.4 days after the surgery. The overall Stage Ⅰ-Ⅱ conversion was 62.7% （32/51） in this study. Within 2 weeks after the surgery, only eight patients received Stage II permanent implantation, and the conversion rate was only 15.7% （8/51 ）, which was much lower than the overall conversion rate of 62.7%. Nearly 84.4% （27/32） of the patients received Stage 11 implantation within 4 weeks. None of the patients had incision infections. In one patient, the entire system was removed 1 month after Stage II implantation due to pain in the implantation site. Conclusions： Appropriate extension of the Stage I testing time of an SNM-barbed electrode could significantly improve the Stage II permanent implantation rate in Chinese refractory LUTS patients; there were no wound infections, and the postoperative complication rate was low. This study recommended that Stage I period of SNM therapy should be 4 weeks according to safety and successful conversion rate.
文摘Sacral neuromodulation(SNM)therapy has revolutionized the management of many forms of anal incontinence,with an expanded use and a medium-term efficacy of 75%overall.This review discusses the technique of SNM therapy,along with its complications and troubleshooting and a discussion of the early data pertaining to peripheral posterior tibial nerve stimulation in incontinent patients.Future work needs to define the predictive factors for neurostimulatory success,along with the likely mechanisms of action of their therapeutic action.
