ABSTRACT
Objective:To investigate the safety and efficacy of sacral neuromodulation(SNM)therapy for the treatment of lower urinary tract dysfunction(LUTD)in elderly patients.Methods:Clinical data of 91 elderly patients with LUTD from multiple medical institutions who received SNM during the period from January 2012 to December 2016 were retrospectively analyzed.Patients were divided into four groups: the interstitial cystitis(IC)group(n=28), the neurogenic bladder(NB)group(n=36), the overactive bladder syndrome(OAB)group(n=13)and the idiopathic dysuria(ID)group(n=14). Different sets of evaluation parameters were used for different diseases.Patients’ baseline data and data in stage I(test phase)and stage Ⅱ(permanent SNM)were recorded, statistically analyzed and compared.Results:Ninety-one people underwent SNM treatment.Of them, 53 patients received permanent implants(stage Ⅱ), and the total conversion rate of stage I to stage Ⅱ was 58.2%(53/91). Patients receiving permanent implants(stage Ⅱ)had a preoperative period ranging from 3 months to 30 years, and were followed up for 2 to 58 months after treatment, with an average follow-up of 19.6 months.The improvement rates in stage I for urinary urgency, daily urination frequency, daily nocturnal urination frequency, maximum urine volume, daily average urine volume, daily urine leakage frequency, and quality of life score were 35.4%, 31.6%, 33.7%, 32.6%, 49.2%, 43.2% and 13.2%, respectively.The improvement rates in stage Ⅱ for urinary urgency, daily urination frequency, daily nocturnal urination frequency, maximum urine volume, daily average urine volume, daily urine leakage frequency, and quality of life score were 43.2%, 40.0%, 37.8%, 50.5%, 70.5%, 70.4% and 43.2%, respectively.Three adverse events occurred, including 1 case of recurrent symptoms, 1 case of moderate infection, and 1 case of electrical lead dislocation.Conclusions:Sacral nerve stimulation has definitive and consistent curative effects on LUTD in elderly people.The follow-up time should be extended to further study the safety of sacral nerve stimulation.
ABSTRACT
Objective To compare the outcomes between interstitial cystitis/bladder pain syndrome (IC/BPS)patients treated with three-drug combination (M blockers + alpha blockers + Amitriptyline) and Sodium hyaluronate intravesical instillation.Methods The patients who came to Second Affiliated Hospital of Nanjing Medical University during October 2014 to September 2015 were investigated if they had IC/BPS.According to the treatment plan,27 patients (group A) received three-drug combination (M blocker + alpha blockers + Amitriptyline)therapy.Thirty-eight patients recelved instillation of sodium hyaluronate (40 mg/50 ml) therapy (group B).Intravesical instillations were performed weekly in the first 6 weeks,and monthly until sixth month.Interstitial cystitis symptom index,interstitial cystitis problem index,overactive bladder symptom score,visual analogue scale/score,the maximum urination and self-rating depression scale were assessed at baseline and the sixth month.Measurement data were expressed as ((x) ±s),t test was used for comparison between groups,and paired t-test was used for comparison of paired data.Results There were 65 patients.Age range was 25-73 years,course of disease (2-99 months),average age (51.4 ± 13.5),average duration (39.8 ± 31.0) months,of which 9 male (13.8％) and 56 female (86.2％) patients.The group A variation of ICSI、ICPI、OABSS、VAS、SDS and maximum urination were 3.7 ± 2.4、1.3 ± 1.5、1.2 ± 1.3、2.1 ± 1.5、3.1 ± 4.5、74.6 ± 52.4,The variation of group B ware 6.8 ± 3.6、5.0 ± 3.8、2.5 ± 1.8、2.8 ± 1.7、8.9 ± 6.4、109.0 ± 81.1.The improvement in ICSI,ICPI,OABSS,SDS of group B were higher than group A (P ＜ 0.05).Conclusion IC/BPS seriously affect the quality of life and the patients are prone to depression.The sodium hyaluronate intravesical instillation therapy could achieve more effect than the three-drug combination therapy.
ABSTRACT
Objective Little is known about the effects of antioxidant on the micturition function in diabetic cystopathy .In this study, we investigated the effects of antioxidant sulforaphane on bladder micturition function in diabetes mellitus ( DM)mice with bladder underactivity . Met hods We established DM models in mice by intraperitoneal injection of a single dose of streptozotocin (STZ)at 65 mg/kg and randomly divided them into three groups , sulforaphane treatment (n=10), vehicle treatment (n=10), and DM model (n=10), with another 10 normal healthy mice included as blank controls.At 24 weeks of the experiment, we obtained and analyzed such indexes of mice as the body weight , fasting blood glucose (FBG), 24-hour urine volume (24 h UV) and bladder wet weight ( BWW ) , results of cystometrography , and cystometric parameters including intercontraction interval ( ICI ) , maximum bladder pressure during micturition ( Pmax ) , maximum cystometric capacity (MCC), void volume (VV), post-void residual urine vol-ume (PVR) and residual urine rate (RUR). Results Compared with the blank controls , the DM models with bladder underactivity showed significantly increases in BWW ([67.96 ±2.35]mg), 24 h HU ([22.47 ±1.93]mL), MCC ([0.70 ±0.03]mL), VV (0[.23 ±0.01]mL), PVR ([0.49 ±0.02]mL), RUR ([70.10 ± 0.80]%), and ICI, but a remarkable decrease in Pmax .Sulforaphane treatment significantly reduced BWW ([576.9 ±2.41]mg), 24 h HU ([16.27 ±1.51] mL), MCC ([0.54 ±0.03]mL), PVR ([0.34 ±0.02]mL), RUR ([62.71 ±1.26]%), and ICI of the diabetic mice . Conclusion Sulforaphane could improve bladder micturition function in mice with STZ-induced DM , which might be related to its action mechanism of antioxidative stress damage .