使用新型倒刺电极的骶神经调节治疗神经源性膀胱的初步临床结果

目的探讨应用新型倒刺电极（Tined-lead）对神经源性膀胱患者行S骶神经调节（SNM）的初步疗效。方法对5例神经源性膀胱患者采用新型倒刺电极，在X线监测下将电极植入S3骶神经孔，进行SNM。术前、术后详细记录排尿日记，用影像尿动力学方法评估患者的膀胱尿道功能。结果患者1（隐性骶裂）术后排尿次数和排尿量分别改善22％和49％；患者2（隐性骶裂）术后排尿次数、排尿量和残余尿量分别改善0．7％、11％和46％；患者3（隐性骶裂）术后排尿次数、排尿量和残余尿量分别改善0．4％、18％和44％。患者4（脑外伤）术后漏尿次数和漏尿量分别改善36％和54％。患者5（高位截瘫）术后间歇导尿次数和导尿量分别改善42％和54％，尿动力学参数改善37％～45％。结论用新型倒刺电极进行SNM为神经源性膀胱的治疗提供了一条新的可供选择的微创方法。

Preliminary clinical report of treatment for neurogenic bladder by sacral neuromodulation using a new tined-lead electrode

Objective To explore the effects of sacral neuromodulation using a new tined-lead electrode on neurogenic bladder. Methods The use of a new tined-lead electrode for sacral neuromodulation was evaluated in a study including 5 consecutive patients with neurogenic bladder. The tined leads were implanted at the $3 foramen under the X-ray screening. Subjects completed the record- ing of detailed voiding diary pre- and post-operation including fluid intake, voided volume, leaked volume, catheterized volume, frequency, accompanying symptoms and sensation. Vesicourethral function was assessed by video-urodynamics. Results Urinary fre- quency and voided volume were improved 22% and 49% respectively in one patient with spinal bifida. Urinary frequency, voided volume and residual volume were improved 0.7 %, 11% and 46 % respectively in another one. Urinary frequency, voided volume and residual volume were improved 0. 4%, 18% and 44% respectively in the third one. Frequency of leakage and leaked volume were improved 36% and 54% respectively in the patient with brain trauma. Frequency of CIC and catheterized volume were improved 42% and 54% respectively, and indexes of urodynamics were improved 37%-45% in the patient with spinal cord injury. Conclusion A new tined-lead electrode for sacral neuromodulation provide a new alterative and minimally invasive procedure to treat neurogenic bladder.