Reprogramming Sacral Neuromodulation for Sub-Optimal Outcomes: Evidence and Recommendations for Clinical Practice.
Reprogramming Sacral Neuromodulation for Sub-Optimal Outcomes: Evidence and Recommendations for Clinical Practice.
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DOI：
10.1111/ner.13494
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发表时间：
2021-10
期刊：
影响因子：
2.8
通讯作者：
de Wachter, Stefan
中科院分区：
文献类型：
--
作者：
Dudding, Thomas C.;Lehur, Paul A.;Sorensen, Michael;Engelberg, Stefan;Bertapelle, Maria Paola;Chartier-Kastler, Emmanuel;Everaert, Karel;Van Kerrebroeck, Philip;Knowles, Charles H.;Lundby, Lilli;Matzel, Klaus E.;Munoz-Duyos, Arantxa;Rydningen, Mona B.;de Wachter, Stefan
在一些接受骶神经调节（SNM）治疗的尿失禁或大便失禁患者中，症状持续存在，可能会发生刺激的疗效降低或不良反应。在这种情况下，SNM设备的进一步编程可以帮助解决问题。很少检测到硬件故障。本文旨在为解决SNM治疗过程中出现的次优结局（故障排除）提供实用指导。进行了系统的文献综述。来自多学科专家组的集体临床经验被用于在缺乏证据的情况下形成意见。描述了需要重新编程的情况。采取的措施包括电极配置、刺激幅度、脉冲频率和脉冲宽度的变更。介绍了由一组欧洲专家开发的刺激的功效损失和不良影响的情况下的指南。此外，还描述了各种硬件故障情况及其管理。重新编程旨在进一步改善患者症状或确保舒适的治疗。电极配置的初始变更和刺激参数的调整可在家中进行，以避免不必要的医院就诊。一个合理的和逐步的方法来重新编程可以改善治疗的结果和恢复患者的满意度。
In some patients treated for urinary or fecal incontinence with sacral neuromodulation (SNM) persistence of symptoms, a reduction in efficacy or adverse effects of stimulation can occur. In such situations, further programming of the SNM device can help resolve problems. Infrequently hardware failure is detected. This article aims to provide practical guidance to solve sub‐optimal outcomes (troubleshooting) occurring in the course of SNM therapy. A systematic literature review was performed. Collective clinical experience from an expert multidisciplinary group was used to form opinion where evidence was lacking. Circumstances in which reprogramming is required are described. Actions to undertake include changes of electrode configuration, stimulation amplitude, pulse frequency, and pulse width. Guidance in case of loss of efficacy and adverse effects of stimulation, developed by a group of European experts, is presented. In addition, various hardware failure scenarios and their management are described. Reprogramming aims to further improve patient symptoms or ensure a comfortable delivery of the therapy. Initial changes of electrode configuration and adjustment of stimulation parameters can be performed at home to avoid unnecessary hospital visits. A logical and stepwise approach to reprogramming can improve the outcome of therapy and restore patient satisfaction.
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