Early Sacral Neuromodulation Prevents Urinary Incontinence After Complete Spinal Cord Injury
Early Sacral Neuromodulation Prevents Urinary Incontinence After Complete Spinal Cord Injury
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DOI：
10.1002/ana.21814
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发表时间：
2010-01-01
影响因子：
11.2
通讯作者：
Stenzl, Arnulf
中科院分区：
文献类型：
--
作者：
Sievert, Karl-Dietrich;Amend, Bastian;Stenzl, Arnulf
背景资料：本研究的目的是探讨通过早期植入双侧骶神经调制器（SNMs）在完全性脊髓损伤（SCI）患者在急性膀胱反射消失phase.Methods：10例神经学证实的完全性脊髓损伤（SCL）患者提供了双侧SNMs在张力不足逼尿肌阶段对人类神经和盆腔器官的潜在影响。通过将两个电极植入每个S-3孔来实现调制。6例患者拒绝并作为对照。平均随访26.2个月。结果：视频尿动力学（VU）证实逼尿肌收缩，导致排尿困难以及显着减少尿路感染（UTIs）。肠运动不需要口服泻药;额外的预编程参数实现勃起性交。解释：SCI患者早期SNM植入可能会彻底改变神经源性下尿路（LUT）功能障碍的管理;它防止逼尿肌过度活动和尿失禁，确保正常的膀胱容量，降低UTI率，并改善肠道和勃起功能而不损伤神经。未来将进行SCI调查，以评估更早的SNM放置的潜在好处，以逐步提高盆腔器官功能。这种新的方法可以提供重要的线索，评估神经元信息是否通过交感神经干神经节传递到大脑后完全SCI。需要进一步的研究来确定功能性磁共振成像（fMRI）是否有助于分析SNM患者和服用抗毒蕈碱药物患者的脑功能变化。神经网络2010;67：74-84
Background: The study aim was to investigate potential influences on human nerves and pelvic organs through early implantation of bilateral sacral nerve modulators (SNMs) in complete spinal cord injury (SCI) patients during the acute bladder-areflexia phase.Methods: Ten patients with neurologically-confirmed complete spinal cord lesions (SCLs) were provided with bilateral SNMs during the phase of atonic-detrusor muscle. Modulation was achieved by two electrodes implanted into each S-3-foramen. Six patients declined and served as controls. The mean follow-up was 26.2 months.Results: Videourodynamics (VU) confirmed detrusor acontractility, resulting in urinary continence as well as significant reductions in urinary tract infections (UTIs). Bowel movements did not require oral laxatives; additional preprogrammed parameters achieved erections for intercourse.Interpretation: Early SNM implantation in SCI patients may revolutionize neurogenic lower urinary tract (LUT) dysfunction management; it prevented detrusor overactivity and urinary incontinence, ensured normal bladder capacity, reduced UTI rates, and improved bowel and erectile functionality without nerve damage.Conclusion: Future SCI investigations will be conducted to evaluate the potential benefits of even earlier SNM placement to progressively enhance pelvic organ functionality. This new approach may provide important clues required for assessing whether neuronal information is passed through the sympathetic trunk ganglion to the brain after complete SCI. Further investigations are needed to determine if functional magnetic resonance imaging (fMRI) might be helpful for analyzing changes in brain function in patients with SNMs and those taking antimuscarinics. ANN NEUROL 2010;67:74-84