生物反馈电刺激治疗女性压力性尿失禁疗效评价（附30例报告）

目的 通过生物反馈电刺激治疗女性压力性尿失禁30例，探讨其疗效，寻找较好的保守治疗女性压力性尿失禁的方法。方法 选择30例Ⅰ～Ⅱ度女性压力性尿失禁的患者，使用生物反馈治疗仪进行生物反馈电刺激治疗，每次20min，隔日1次，10次为1个疗程，疗程结束后3个月开始观察疗效，随访6个月。结果 30例患者中治愈20例（67％），有效7例（23％），无效但未发展的3例（10％），有效率达90％。结论 生物反馈电刺激治疗Ⅰ～Ⅱ度女性压力性尿失禁是一种有效的、治愈率较高的保守治疗方法。     

盆底生物反馈联合电刺激治疗女性压力性尿失禁

目的探讨盆底生物反馈联合电刺激治疗女性压力性尿失禁（stress urinary incontincnce,SUI）和压力/急迫混合性尿失禁（mixed urinary incontinence,MUI）的临床效果。方法2006年5月-2007年6月对40例轻中度女性尿失禁患者（SUI 22例,MUI 18例）,采用生物反馈治疗仪进行盆底生物反馈联合电刺激的训练治疗,治疗时间20-30 min,3次/周,疗程2个月。结果40例均获随访,平均8.9（3-14）个月。治愈14例（35.0%）,改善16例（40.0%）,无效10例（25.0%）,总有效率为75.0%;其中SUI有效率为77.3%（17/22）,MUI有效率为72.2%（13/18）。除少数患者插入探头时有轻微不适感外,无其他明显不适,无阴道感染等不良反应发生。但有5例治疗有效的患者症状复发。结论盆底生物反馈联合电刺激治疗女性轻中度SUI或MUI安全有效、治愈率较高。治疗后如能继续坚持Kegel操盆底肌锻炼有助于预防尿失禁的复发。     

盆底生物反馈联合电刺激治疗男性TUR-P术后尿失禁的临床观察

尿失禁 (urinarv incontinence,UI)是男性TUR-P术后常见的并发症之一,严重影响着患者的生活质量[1].我院与仁济医院联合自2007年1月至2008年12月应用盆底生物反馈联合电刺激(主动性+被动性盆底肌肉训练)治疗TUR-P术后的尿失禁患者,取得良好的治疗效果,现报道如下.     

生物反馈联合电刺激治疗小儿充溢性大便失禁的疗效观察

目的:探讨生物反馈联合电刺激治疗小儿充溢性大便失禁的近期疗效.方法:应用生物反馈电刺激仪,对20例充溢性大便失禁患儿进行综合治疗(实验组),包括功能性大便失禁患儿10例(A组),神经源性大便失禁10例(B组),治疗时间20～30 min,每周治疗5次,20次为1个疗程.另选10例脊髓栓系松解术后引起的充溢性大便失禁患儿仅行盆底肌训练作为对照组(C组).治疗前后均行临床失禁程度分级,肛门直肠测压及盆底肌电图检查.结果:随访3～5年,平均4.5年.A、B 2组患儿治疗后临床评分4.8±0.6,3.4±0.5;肛门最大收缩压(187.5±5.5)mm Hg,(130.8±3.9)mm Hg;持续收缩时间(9.3±1.3)s,(5.1±1.2)s;直肠感觉阈值(23.5±5.7)mL,(34.9±3.9)mL;肛门外括约肌收缩振幅(286.6±58.3)μV,(228.5±33.1)μV;阴部神经潜伏期(34.8±10.5)ms,(47.4±8.0)ms,与治疗前比较差异均有统计学意义(P<0.05),功能性大便失禁患儿疗效优于神经源性大便失禁患儿,神经源性综合训练组优于神经源性对照组(P<0.05).结论:生物反馈联合电刺激训练是治疗充溢性大便失禁一种可以选择的有效方法.     

电刺激联合盆底肌训练治疗压力尿失禁的疗效观察

目的探讨观察电刺激联合盆底肌训练治疗压力性尿失禁（SUI）的疗效。方法选取经尿动力学检查证实为SUI患者56例,其中男9例,女47例,平均（46±5）岁。采用盆底生物反馈治疗仪进行电刺激联合盆底肌训练,每次32min,每天1次,6周为1疗程。记录治疗前、后患者排尿日记和尿动力学测定,并随访2个月疗效。结果56例全部完成治疗。其中尿失禁症状完全消失10例（17％）,漏尿点压测定无漏尿发生7例（13％）。治疗后总排尿次数（8±2）次／24h、总漏尿事件次数（7±2）次／24h,显著低于治疗前的（15±4）次／24h、（12±3）次／24h（均P〈0．05）;最大排尿量、正常尿意膀胱压测定容量、最大膀胱压测定容量、漏尿点压和最大尿道闭合压分别为（256±47）L、（260±48）mL、（277±46）mL、（96±10）cmH2O和（62±7）cmH,显著高于治疗前的（143±35）mL、（135±37）mL、（162±33）mL、（79±12）cmH2O和（54±6）cmH2O,差异有统计学意义（均P〈0．05）。治疗结束时和2个月后有效率为91％和88％,差异无统计学意义（P〉0．05）。结论电刺激联合盆底肌训练是治疗SUI的一种有效方法。     

生物反馈电刺激联合阴式子宫切除术在老年盆腔器官脱垂中的应用效果

目的 探讨生物反馈电刺激（BF-FES）联合阴式子宫切除术（TVH）在老年盆腔器官脱垂（POP）患者中的应用效果。 方法 选取2020年7月至2022年12月陆军军医大学士官学校附属医院收治的92例老年POP患者作为研究对象,依据随机数字表法分为观察组（45例）与对照组（47例）。对照组实施TVH治疗,术后常规进行盆底康复训练;观察组在对照组基础上实施BF-FES治疗,均连续治疗4周并随访6个月。比较两组治疗前、治疗4周表面肌电值、三维盆底超声参数及尿动力学指标,比较治疗前、治疗4周及随访3个月、6个月的1h尿垫试验结果。 结果 两组患者治疗4周各阶段表面肌电值高于治疗前。观察组前静息、快速收缩、紧张收缩、耐力收缩及后静息阶段表面肌电值均高于对照组（ P<0.05）。两组治疗4周膀胱颈移动度高于治疗前,尿道膀胱后角、尿道旋转角度低于治疗前。观察组膀胱颈移动度高于对照组,尿道膀胱后角、尿道旋转角度低于对照组（ P<0.05）。两组治疗4周最大尿流率、最大膀胱容量、平均尿流率高于治疗前,残余尿量低于治疗前;观察组最大尿流率、最大膀胱容量、平均尿流率高于对照组;观察组残余尿量低于对照组（ P<0.05）。治疗4周、随访3个月、随访6个月两组患者1 h尿垫重量增加量与治疗前比较逐渐降低,且观察组治疗后低于对照组（ P<0.05）。 结论 BF-FES联合TVH能显著增强老年POP患者盆腔肌力,改善盆底超声参数及尿动力学指标,对患者尿失禁的治疗效果显著。     

生物反馈电刺激联合推拿治疗先天性肌性斜颈的临床研究

目的 探讨生物反馈电刺激联合推拿治疗先天性肌性斜颈的临床疗效.方法 选择2016年10月～2019年9月收治的126例先天性肌性斜颈患者,按随机数字表法分为对照组和联合组各63例.对照组给予推拿治疗,联合组在对照组的基础上联合生物反馈电刺激治疗.比较两组的头部偏斜角度、患侧屈向健侧度、颈部旋转度、肿块体积和临床疗效.结...     

盆底肌训练联合电刺激生物反馈用于原位新膀胱术后患者尿失禁干预

目的 探究盆底肌训练联合电刺激生物反馈用于原位新膀胱术后患者尿失禁的效果。方法 将97例膀胱癌行原位新膀胱术患者按时间段分为对照组46例、观察组51例;对照组实施术后常规盆底肌训练;观察组在对照组基础上增加盆底电刺激联合生物反馈干预。干预2个疗程后评价效果。结果 观察组尿失禁干预有效率、膀胱容量、尿流率、膀胱逼尿肌压力、排尿间隔时间及平均每次尿量均显著优于对照组（均P＜0.05）。结论 盆底肌训练联合电刺激生物反馈可有效改善膀胱癌原位新膀胱术后患者尿失禁,提高尿控能力。     

生物反馈电刺激在膀胱排尿功能障碍治疗中的进展

膀胱排尿功能障碍主要表现为以尿频、尿急等下尿路症状,膀胱过度活动症,尿失禁,排尿困难,尿潴留等［1］。在临床实践过程中,由尿路结石、肿瘤、前列腺增生等引起的机械性梗阻可通过手术治疗取得较好的疗效,但神经源性下尿道功能障碍采用传统保守治疗不能取得很好的疗效,手术治愈率低且并发症较多［2］。近年来,随着生物反馈电刺激疗法在临床上的应用,在尿失禁、膀胱过度活动症的治疗及下尿路症状的缓解中取得了较好的疗效,为泌尿科医生提供了一种有效的新方法。目前,已被临床证实有效的治疗方法有膀胱内、骶神经、阴部神经、生殖器背神经、胫后神经电刺激等［3］。虽然膀胱内和骶神经电刺激在神经源性排尿功能障碍方面有较好的疗效,但二者需要有创操作或植入永久电极,费用昂贵且并发症较多,非侵入性电刺激：阴部神经、生殖器背神经、胫后神经电刺激具有无创、可调、易操作等优点,同时电刺激联合生物反馈治疗能够取得更好的疗效。现就非侵入性电刺激及生物反馈联合电刺激对排尿功能障碍治疗的研究进展综述如下。     

功能性电刺激联合生物反馈盆底肌锻炼治疗慢性盆腔疼痛综合症

目曲评估功能性电刺激联合生物反馈盆底肌锻炼治疗慢性盆腔疼痛综合症的效果。方法回顾性分析本院2007年2月～2008年9月应用功能性电刺激联合生物反馈盆底肌锻炼治疗慢性盆腔疼痛综合症39例。治疗电流频率20Hz,脉冲期2ms,电流强度为10-50mA,每次治疗30min,每周5次。治疗前后分别进行进行疼痛评分[采用疼痛评分表（VAS）]和生活质量评分[采用慢性前列腺症状评分指数表（NIH—CPSI）]。结果治疗后疼痛评分显著降低（2．62±1．86vs．4．77±1．58,P〈0．05）,生活质量评分显著改善（4．82±2．15vs.7．38±1．71,P〈0．05）。结论功能性电刺激联合生物反馈盆底肌锻炼可以显著缓解慢性盆腔疼痛综合症的疼痛症状,改善患者生活质量。     

生物反馈和电刺激联合治疗慢性前列腺炎/慢性骨盆疼痛综合征

目的:通过临床试验的方法,探讨生物反馈和电刺激联合治疗慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)的效果。方法:收集湘雅医院门诊诊断为CP/CPPS符合研究标准患者140例。将患者随机分为对照组、生物反馈组、电刺激组和生物反馈加电刺激组;对照组20例,生物反馈组、电刺激组和生物反馈加电刺激组各40例。采用Laborie-Urostym生物反馈电刺激治疗仪,生物反馈组行生物反馈治疗,电刺激组行电刺激治疗,生物反馈加电刺激组行生物反馈电刺激治疗;每周5次,连续2周;对照组不予上述治疗,随诊1个月。治疗前后进行NIH-CPSI评分以及尿流率检查。结果:生物反馈组、电刺激组和生物反馈加电刺激组治疗后NIH-CPSI疼痛与不适评分、NIH-CPSI排尿症状评分、NIH-CPSI生活质量评分、NIH-CPSI总评分、最大尿流率较治疗前均有显著改善(P<0.05);治疗前各组积分及最大尿流率比较无显著差异(P>0.05);治疗后上述参数生物反馈组、电刺激组比较没有显著差异(P>0.05),生物反馈加电刺激组与生物反馈组、电刺激组比较有显著差异(P<0.05)。而对照组治疗前后的以上各组评分及最大尿流率比较无显著差异(P>0.05)。结论:生物反馈和电刺激治疗能明显改善CP/CPPS患者疼痛与不适症状,排尿症状,提高生活质量,以及提高最大尿流率。生物反馈和电刺激联合治疗CP/CPPS有协同作用。     

Simultaneous perineal ultrasound and vaginal pressure measurement prove the action of electrical pudendal nerve stimulation in treating female stress incontinence

Study Type – Diagnostic (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Pelvic floor muscle training (PFMT) and transvaginal electrical stimulation (TES) are two commonly used forms of conservative treatment for stress urinary incontinence (SUI). PFMT may build up the structural support of the pelvis, but many SUI patients are unable to perform PFMT effectively and its primary disadvantage is lack of long‐term patient compliance. TES is a passive treatment that produces PFM contraction and patient compliance with it is good; however, its effect is not as good as that of PFMT when performed correctly. Electrical pudendal nerve stimulation (EPNS) combines the advantages of PFMT and TES and incorporates the technique of deep insertion of long needles. In this study, simultaneous perineal ultrasound and vaginal pressure measurement prove that EPNS can contract the PFM and simulate PFMT. It is shown that EPNS is an alternative therapy for female SUI patients who fail PFMT and TES and the therapy can also be used for severe SUI.

OBJECTIVES

• ? To prove that electrical pudendal nerve stimulation (EPNS) can contract the pelvic floor muscles (PFM) and simulate pelvic floor muscle training (PFMT).
• ? To show that EPNS is an alternative therapy for female stress urinary incontinence (SUI) that does not respond effectively to PFMT and transvaginal electrical stimulation (TES).

PATIENTS AND METHODS

• ? Thirty‐five female patients with SUI who did not respond effectively to PFMT and TES (group I) were enrolled and 60 other female patients with SUI were allocated to group II (30 patients) and group III (30 patients).
• ? Long needles were deeply inserted into four sacral points and electrified to stimulate the pudendal nerves. Group I and group II were treated by a doctor skilled in performing EPNS and group III, by a doctor unskilled in performing EPNS.
• ? When EPNS was performed in group I, perineal ultrasonographic PFM movements, vaginal pressure (VP) and PFM electromyography were recorded simultaneously.
• ? The therapeutic effects were evaluated according to objective and subjective criteria

RESULTS

• ? When EPNS was performed correctly, the patient felt strong PFM contractions. Simultaneous recordings in group I showed: B‐mode cranio‐caudal PFM movements; M‐mode PFM movement curves (amplitude: about 1 mm, n= 31); a sawtooth curve of VP changes (2.61 ± 1.29 cmH₂O, n= 34); and PFM myoelectric waves (amplitude: 23.9 ± 25.3 µV).
• ? If during the EPNS process the electric current was stopped or its intensity was reduced to about 7–12 mA or the two lower needles were drawn back, then the above ultrasonographic PFM movements and VP changes disappeared.
• ? In group I, the incontinence severity and quality of life score was 16.5 ± 4.0 before treatment and decreased to 4.2 ± 4.0 after 27.5 ± 11.9 sessions of treatment (P < 0.01). At the end of treatment, 100% improvement occurred in 16 cases (45.7%). A 2‐year follow‐up showed that 100% improvement occurred in 14 of cases (40.0%).
• ? In group II, the incontinence severity and quality of life score was 17.1 ± 6.3 before treatment and decreased to 3.5 ± 3.7 after 10 sessions of treatment (P < 0.01) and 100% improvement occurred in 12 cases (40.0%). In group III, the incontinence severity and quality of life score was 17.6 ± 6.3 before treatment and decreased to 10.8 ± 8.2 after 10 sessions of treatment (P < 0.01) and 100% improvement occurred in one case (3.3%).
• ? The post‐treatment score was lower and the therapeutic effect was better in group II than in group III (both P < 0.01).

CONCLUSIONS

• ? EPNS can contract the PFM and simulate PFMT.
• ? EPNS is an alternative therapy for female SUI patients who fail PFMT and TES.

     

Transvaginal electrical stimulation in the treatment of urinary incontinence

OBJECTIVE: To determine the effectiveness of transvaginal electrical stimulation (TES) in treating urinary incontinence, and to assess the clinical improvement 6 months after ending the treatment. PATIENTS AND METHODS: In a double-blind randomized controlled clinical trial, 36 women (24 patients and 12 controls) with stress, urge or mixed urinary incontinence were chosen to use TES or placebo (identical equipment but with no electrical current). The patients had their treatment at home twice a day (20-min sessions) for 12 weeks. They completed a voiding diary and had a urodynamic study at the beginning and end of treatment. They were clinically re-evaluated after 6 months. RESULTS: The mean time of use of TES was similar in both groups (approximately 40 h); the treatment group had a significant increase in maximum bladder capacity (P < 0.02), a significant reduction in the total number of voids (over 24 h; P < 0.02), in the number of episodes of voiding urgency (P < 0.001) and, importantly, in the number of episodes of urinary incontinence (P < 0.001). At the first evaluation, after ending the treatment, 88% of the patients had a significant reduction in symptoms or went into remission. At the 6-month re-evaluation, a third of the patients required another therapeutic approach. CONCLUSION: TES is a practical alternative with few side-effects, and is effective for treating the main forms of female urinary incontinence.     

Efficacy of functional electrical stimulation in treating genuine stress incontinence: A randomized clinical trial

Our objective was to determine the efficacy of functional electrical stimulation as a stand-alone therapy for female stress incontinence. The study was conducted as a prospective, double-blind, randomized controlled trial using subjective and objective outcome criteria. Patients enrolled in this study had stress incontinence consistent with International Continence Society criteria. Patients with significant pelvic prolapse or detrusor instability were excluded. Patients underwent twice-daily treatment sessions for a total of 3 months. Results were analyzed for confounding variables between the treatment and control groups. Statistical analysis was performed utilizing Fisher's exact test and the paired t-test. Of the 54 patients enrolled in this study, 44 completed the program. The dropout rate was similar for both the treatment and control groups. There was no statistically significant difference between the treatment and control groups with regard to age, gravity, parity, previous antiincontinence surgery, menopausal status, or previous hysterectomy. Objective success for the treatment group was 15% and for the control group, 12.5% (NS). The subjective success for the treatment group was 25% and for the control group, 29% (NS). There was no relationship demonstrated between age, parity, previous surgery, hysterectomy, or menopausal status and the successful treatment of genuine stress incontinence with functional electrical stimulation. In this patient population, functional electrical stimulation was no more effective at improving or eliminating the symptoms of genuine stress incontinence than was the daily retention of the control probe. Neurourol. Urodynam. 16:543–551, 1997. © 1997 Wiley-Liss, Inc.     

生物反馈联合盆底肌训练治疗女性压力性尿失禁的疗效

目的:探讨生物反馈联合盆底肌训练治疗女性压力性尿失禁(Stress urinary incontinence,SUI)的临床效果.方法:2005年11月～2007年3月,对11例女性SUI患者使用生物反馈治疗仪进行生物反馈电刺激联合盆底肌训练治疗.治疗前通过病史、体检、尿动力学检查诊断为尿失禁.治疗每次20 min,每天1次,5次为1个疗程.结果:11例女性SUI患者中,7例症状消失,4例症状减轻.追踪观察6个月,无一例复发.结论:生物反馈联合盆底肌训练是一种安全、有效的治疗女性SUI的方法.     

Percutaneous electrical nerve stimulation in children with therapy resistant nonneuropathic bladder sphincter dysfunction: a pilot study

PURPOSE: We evaluated the effect of percutaneous electrical nerve stimulation on voiding dysfunction in a group of children with therapy resistant, nonneuropathic bladder sphincter dysfunction. MATERIALS AND METHODS: In a prospective study 17 boys and 15 girls with mean age of 11.7 years underwent percutaneous electrical nerve stimulation after the failure of more than 2 years of urological and/or pharmacotherapy. The device for percutaneous electrical nerve stimulation consists of an interface cable, a surface electrode, a percutaneous needle and a portable stimulator. The needle is inserted at the tibial nerve level and a portable stimulator provided pulsations at a frequency of 20 Hz. for 30 minutes once weekly. Every 6 weeks the children were evaluated. Evaluation parameters were urgency, daytime incontinence, voiding frequency, the uroflowmetry curve and bladder capacity. When favorable results were observed after 6 sessions, therapy was continued for another 12 sessions. In 24 children anticholinergics started before stimulation that had only a partial effect were continued during stimulation. RESULTS: In 7 of the 28 children with urgency before therapy it disappeared after therapy and in 10 it improved. Of the 23 children with daytime incontinence before treatment 4 became dry after stimulation and in 12 incontinence decreased. Of the 19 patients who reported disturbed voiding frequency of less than 4 or more than 8 voids daily 16 achieved a normal frequency of 4 to 6 voids daily. In 21 children an abnormal uroflowmetry curve was observed before stimulation, while in 9 the flow curve was normal after therapy. Mean bladder capacity increased significantly from 185.16 to 279.19 ml. CONCLUSIONS: Percutaneous electrical nerve stimulation has a significant effect on voiding frequency, the uroflowmetry curve and bladder capacity in children with nonneurogenic bladder sphincter dysfunction