Sacral neuromodulation effective for neurogenic bladder: a Meta-analysis / 现代泌尿外科杂志

【Objective】 To evaluate the efficacy of sacral neuromodulation (SNM) in the treatment of neurogenic bladder (NB) with Meta-analysis, so as to provide reference for clinical treatment options for NB. 【Methods】 Relevant literatures regarding the efficacy of SNM in treating NB during Jan.2010 and Dec.2022 were collected from the PubMed and CNKI databases, and screened with inclusion and exclusion criteria.After the quality of literatures was assessed, data were extracted and then analyzed using Review Manager 5.3. 【Results】 The research included 14 studies involving 601 patients.Meta-analysis showed that SNM significantly improved urinary frequency (WMD=4.30, 95%CI: 2.84-5.77, P<0.01), daily episodes of urinary incontinence (WMD=2.92, 95%CI: 2.76-3.07, P<0.01), single void volume (WMD=-113.93, 95%CI: -159.91- -67.98, P<0.01), maximum flow rate (WMD=-3.23, 95%CI: -4.04- -2.42, P<0.01), residual urine (WMD=111.79, 95%CI: 79.93-143.64, P<0.01), maximum bladder capacity (WMD=-65.63, 95%CI: -84.38- -46.88, P<0.01), and bladder compliance (WMD=-4.65, 95%CI: -8.75- -0.55, P=0.03). 【Conclusion】 SNM is effective in the treatment of NB, but more randomized controlled trials are needed to verify the efficacy.

Sacral neuromodulation therapy for urinary and defecatory disorders: experience in a Latin American public hospital

Abstract Objective: To show the experience of a Latin American public hospital, with SNM in the management of either OAB, NOUR or FI, reporting feasibility, short to medium-term success rates, and complications. Methods: A retrospective cohort was conducted using data collected prospectively from patients with urogynecological conditions and referred from colorectal surgery and urology services between 2015 and 2022. Results: Advanced or basic trial phases were performed on 35 patients, 33 (94%) of which were successful and opted to move on Implantable Pulse Generator (GG) implantation. The average follow-up time after definitive implantation was 82 months (SD 59). Of the 33 patients undergoing, 27 (81%)reported an improvement of 50% or more in their symptoms at last follow-up. Moreover, 30 patients (90%) with a definitive implant reported subjective improvement, with an average PGI-I "much better" and 9 of them reporting to be "excellent" on PGI-I. Conclusion: SNM is a feasible and effective treatment for pelvic floor dysfunction. Its implementation requires highly trained groups and innovative leadership. At a nation-wide level, greater diffusion of this therapy among professionals is needed to achieve timely referral of patients who require it.

Latest advances in the diagnosis and treatment of interstitial cystitis/bladder pain syndrome / 现代泌尿外科杂志

Interstitial cystitis/bladder pain syndrome (IC/BPS) is characterized by pain, oppressing sensation, or discomfort associated with the bladder, accompanied by lower urinary tract symptoms, lasting for more than 6 weeks (or 6 months). Since IC/BPS was first reported, its diagnosis and treatment have been a challenge to clinicians. This article will review its classification and phenotype, fundamental research, imaging, symptom score, cystoscopy, treatment and potential therapeutic targets.

Application of three-dimensional printed guiding device for electrode implantation in sacral neuromodulation in children / 现代泌尿外科杂志

【Objective】 To investigate the application value of three-dimensional printed guiding device in sacral neuromodulation in children. 【Methods】 A total of 17 patients admitted during Jan.2017 and Nov.2022 were divided into two groups: control group (n=8), using traditional method to locate sacral foramen for puncture; three-dimensional printed guiding device group (n=5), using three-dimensional printing technology to make individual guiding device for puncture. The clinical indexes of the two groups were evaluated, including puncture time, puncture numbers, intraoperative X-ray exposure times, postoperative evaluation time and second-stage conversion rate. The evaluation indexes of postoperative complications were wound bleeding, wound infection, wound rupture, electrode fracture, displacement or prolapse. 【Results】 In the control group, 1 case was diagnosed as bladder-bowel dysfunction, the remaining 7 were neurogenic bladder; in the three-dimensional printed guiding device group, all 9 cases were diagnosed as neurogenic bladder. The puncture time was shorter in the three-dimensional printed guiding device group than in the control group [85(70-90) min vs.138(133-208) min], the puncture numbers were fewer [15(12-20) vs.22(18-26)], and the X-ray exposure times were fewer [12(12-17) vs.19(16-23)] (all P<0.05). The initial stimulation voltage, postoperative evaluation time and second-stage conversion rate were not statistically significant. 【Conclusion】 Compared with the traditional method, the use of three-dimensional printed guiding device can reduce the puncture numbers and shorten the puncture time in the process of sacral neuromodulation in children.

Research advances of sacral neuromodulation in the management of pediatric neurogenic bladder / 现代泌尿外科杂志

Pediatric neurogenic bladder (PNB) is defined as dysfunction of the detrusor and/or urethral sphincter due to myelodysplasia or spinal cord injury, manifesting as impaired urination or defecation, which seriously affects the patients’ quality of life. The main indication for sacral neuromodulation (SNM) is overactive bladder syndrome, which presents as refractory urinary frequency and urgency, urgency incontinence and non-obstructive urinary retention. Age more than 16 years are also recommended for this technique. Previous studies have revealed that SNM could significantly improve the outcome of refractory bladder bowel dysfunction. This paper reviews the advances of the application of SNM in the treatment of pediatric neurogenic bladder so as to provide reference for pediatricians.

Reflections and perspectives on sacral neuromodulation in the treatment of refractory overactive bladder disorder / 国际外科学杂志

Overactive bladder (OAB) is a common urological condition. First-line treatment for OAB includes behavioral therapy as well as pharmacological treatment with M-blockers and β3-adrenoceptor agonists. Patients with OAB who fail behavioral therapy and do not achieve the desired outcome after 6-12 weeks of treatment with M receptor antagonists alone or who cannot tolerate the adverse effects of oral medications are referred to as refractory OAB. patients with refractory OAB can be treated with surgical interventions such as Sacral Neuromodulation (SNM), intravesical Botulinum Toxin type A. BTX-A and Percutaneous Tibial Nerve Stimulation. Compared with other procedures, SNM is highly effective and has a low incidence of adverse effects. The author contemplates that future studies of SNM for refractory OAB could be conducted to address the overall changes in intestinal flora-urinary flora-metabolomics and urinary control-related brain structure-spinal cord functional structure-peripheral pelvic floor nerve structure.

Evaluation of sacral neuromodulation system with new six-contact points electrode for the treatment of bladder dysfunction / 中华泌尿外科杂志

Objective:To investigate the effects of sacral neuromodulation (SNM)using the new six-contact electrode vs. the four-contact electrode in patients with refractory overactive bladder.Methods:The clinical data of 29 patients underwent SNM testing therapy from January 2018 to January 2020 in China Rehabilitation Research Center were reviewed. In six-contact points electrode group 16 patients accepted SNM with new six-contact points electrode, while 13 patients in four-contact points electrode group accepted SNM with four-contact points electrode. There were no significant differences between the two group in age [(51.63±4.67) vs. (51.85±7.18) years], gender (male/female, 4/12 and 5/8), urination frequency [(22.10±9.05) vs. (21.79±8.05) times/24h], mean voided volume [(135.68±56.98) vs. (131.00±53.05) ml], and urgency score [(2.78±0.97) vs. (3.02±0.91)] (all P>0.05). The number of sensitive contact points, the ratio of reaction contact points, operation time of stage I and the success rate of two groups were calculated. Results:The mean number of sensitive points of six-contact points electrode group (3.31± 0.95) was significantly higher than that of the four-contact points electrode group (1.85± 0.38), ( P<0.05). There was no significant difference in the ratio of reaction contact points [ (96.87±6.71)% vs. (96.15± 9.39)%] and operation time of stage I [(71.25± 18.21)min vs.(68.85± 10.83)min]between six-contact points electrode group and four-contact points electrode group ( P<0.05). The contact E4 and E5 of six-contact electrodes had similar reaction voltage ( P>0.05). The implant rate of six-contact points electrode group was (14/16, 87.5%), which was higher than that of four-contact points electrode group (10/13, 76.9%), but there was no statistical difference ( P>0.05). Conclusions:This study showed that six-contact electrodes has more sensitive points compared with four-contact electrodes. Application of six contact electrodes, patients might get a higher implant rate.

Efficacy and safety of sacral neuromodulation variable-frequency stimulation in the treatment of refractory lower urinary tract dysfunction / 中华泌尿外科杂志

This study prospectively collected the clinical data of patients who received sacral neuromodulation(SNM)variable-frequency stimulation (VFS) mode from June 2020 to December 2020, in order to explore the efficacy and safety of VFS mode in the treatment of refractory lower urinary tract dysfunction. The inclusion criteria were as follows: ①SNM was implanted; ②age ≥18 years old; ③The traditional constant-frequency stimulation (CFS) mode has poor therapeutic effect, and can not be improved after repeated adjustment of stimulation parameters; ④Patients with overactive bladder (OAB) symptoms, who fail to respond to conservative treatment or are intolerant to conservative treatment; ⑤The drugs that affect the lower urinary tract symptoms and pelvic function should not be increased or decreased during the trial; ⑥provision of informed consent. A total of six patients meeting the criteria were included in the study, with three males and three females. The age ranged from 47 to 74 years, with an average age of 55 years. Among those patients, three cases were diagnosed of OAB, two cases were diagnosed of interstitial cystitis, and one case was diagnosed of neurogenic bladder. All patients had received CFS-SNM for an average of 20.6 months before upgrading to VFS mode, and suffered from severe frequency of urination at the same time. Compared with the severity of symptoms during the baseline period and the CFS period, a trend of improvement was found among four patients during the VFS period. The severity of symptoms was mainly based on the average daily urination frequency and OAB-Q score. For the two patients with interstitial cystitis, OAB symptoms worsened during the VFS period, while the VAS score did not change significantly. In general, VFS-SNM is not inferior to CFS-SNM in improving the symptoms of frequent micturition. For patients with interstitial cystitis, multiple sets of VFS parameters can be tried under the premise of satisfactory pain management.

A retrospective analysis of long-term follow-up of sacral neuromodulation in the management of refractory interstitial cystitis/bladder pain syndrome / 中华泌尿外科杂志

Objective:To summarize long-term outcome of sacral neuromodulation (SNM) for refractory interstitial cystitis/bladder pain syndrome (IC/BPS).Methods:Between January 2013 and October 2020, 28 patients with IC / BPS who received SNM in Beijing Chaoyang Hospital and Hebei Yanda Hospital were retrospectively analyzed. There were 5 males and 23 females, with median age 63.00 (47.50, 66.75) years old. The urgency score was 4 (3, 4) points, 24-hour micturition frequency was 26 (20.50, 32.50) times, nocturia was 9 (7, 12) times, single urine volume was 59.00 (41.25, 79.50) ml, VAS score was 9.0 (8.0, 9.0) points, O′Leary-Sant score was 31.00 (20.25, 33.00) points, and single maximum urine volume was 100.0 (80.0, 127.5) ml. The improvement of symptoms before operation, test period and last follow-up were compared.Results:The urgency score was 2 (1, 3), the 24-hour micturition frequency was 17.00 (15.00, 22.75), the frequency of nocturia was 5.5 (4.0, 7.0), the single urine volume was 87.50 (70.25, 110.00) ml, the VAS score was 4.0 (3.0, 6.0) and the O′Leary-Sant score was 20.00 (17.00, 23.00) in 28 patients during the test period, which were significantly improved compared with those before operation ( P < 0.05). There was no significant difference in the single maximum urine volume of 135.0 (102.5, 160.0) ml between the two groups ( P > 0.05). 28 patients received SNM Ⅱ permanent stimulator implantation. The median follow-up time was 29.5 (21.25, 61.75) months. Among the 28 patients, 3 patients underwent cystectomy and ileal conduit after removal of the complete SNM system due to the unsatisfied results. Twenty-five cases (89.3%) were still treated with SNM. Among them, 6 cases accepted combinative therapy of oral medicine (antihistamines, sodium pentose polysulfate, hormones, immunosuppressants, etc.). Two cases accepted combinative therapy of intravesical instillation, including heparin in one case and sodium hyaluronate in the other one. Three cases accepted combinative therapy of botulinum toxin injection.One case accepted combinative therapy of bladder augmentation. Two cases accepted combinative therapy of traditional Chinese medicine (TCM). One case accepted combinative therapy of oral medicine and TCM. The remaining 10 cases didn't accept any treatment. Among them, 3 cases were still treated with SNM even though they were not satisfied with the effect, including 1 case due to electrode displacement. At the last follow-up of 25 patients, the urgency score was 2 (1, 3), the 24-hour micturition frequency was 16.50 (13.00, 19.75), the frequency of nocturia was 5.5 (4.0, 9.0), the single urine volume was 105.0 (72.5, 120.0) ml, the VAS score was 4.5 (3.0, 6.0) and the O'Leary Sant score was 16.00 (14.00, 22.50), which were significantly improved compared with those before operation ( P < 0.05), but no difference with those during test period ( P>0.05). There was no significant difference in the single maximum urine volume of 125.0 (102.5, 150.0) ml at the last follow-up compared with preoperative and test period ( P>0.05). Conclusions:As a treatment option for refractory IC / BPS, SNM can improve the symptoms of most patients and maintain good long-term efficacy combined with other.

Efficacy and predictive factors of sacral neuromodulation on neurogenic bladder / 中华泌尿外科杂志

Objective:To explore the efficacy of sacral neuromodulation (SNM) in the treatment of neurogenic bladder (NB), and to analyze the predictive factors.Methods:The clinical data of 91 patients underwent SNM testing therapy from January 2012 to January 2020 in China Rehabilitation Research Center were reviewed. There were 53 males and 48 females with the average age of 36.5(28.0-52.5)years. Urinary diary, residual urine, neurogenic bowel dysfunction score (NBDS), video-urodynamic and pelvic floor electrophysiological examination before treatment were recorded. Among the 91 patients, 60 patients had symptoms of urinary storage period, including urgency, frequency and / or incontinence.The average number of voids/24 h was 13 (11, 18), the average volume per void was (123.0±45.9) ml, the average degree of urgency was (3.5±1.0), and the average 24-hour urine leakage was 100.0(50.0, 231.5) ml. 78 patients had chronic urinary retention symptoms, and the average post-void residual volume (PVR) was 200.0 (132.3, 300.0) ml. The neurogenic bowel dysfunction score (NBDs) of 91 patients was 11 (6.25, 13). The mean maximum cystometric capacity (MCC), maximum detrusor pressure (P detmax) and bladder compliance were 250 (117, 369) ml, 33 (17, 72) cmH 2O and 8.275 (4.540, 20.307) ml / cmH 2O, respectively. Pelvic floor electrophysiological examination showed that somatosensory evoked potential (SEP) was normal in 39 cases, abnormal in 19 cases and undetected in 33 cases. Bulbocavernosus reflex (BCR) was normal in 39 patients, abnormal in 23 patients and undetected in 29 patients. At the end of the test phase, the patient was re-evaluated. If " effective" or the patient willing to implant, permanent implantation of pulse generator was done. " Effective" was defined as improvement of more than 50% in at least one of the following conditions, including the number of voids in 24 hours, volume per void, degree of urgency, leakage volume in 24 hours, PVR. Quantitative values were compared using the t-test or non-parametric test. The potential risk factors were considered by logistic regression analysis. Results:The average test time was (18.7±6.7) days. 43/60 patients (71.7%) had improvement of more than 50% in at least one symptom of the storage period, and 21/78 patients (26.9%) had more than 50% improvement in urination symptoms. NBDS decreased from 11(6.25, 13) to 3(0, 8)( P < 0.05). During the filling period, MCC increased from 173.0(98.0, 326.0) ml to 300.0(201.0, 386.0) ml ( P<0.05), P detmax decreased from 40.0(27.0, 84.0) cmH 2O to 22.0(15.0, 60.0) cmH 2O ( P < 0.05), and bladder compliance increased from 6.84(3.75, 11.79) ml/cm H 2O to 19.23(4.95, 32) ml/cm H 2O ( P < 0.05). At the end of the test phase, 54 (59.3%) patients underwent permanent implantation. The median follow-up was 25.5 (11.5, 60.5) months. Four patients lost their curative effect, two patients developed grade 2 vesicoureteral reflux, and one patient underwent cystoplasty. Risk factors analysis showed that chronic urinary retention was a statistically significant variable ( P<0.05). Conclusions:SNM can not only improve the lower urinary tract symptoms of patients with neurogenic bladder, but also improve the urodynamic parameters and bowel function. Patients with chronic urinary retention symptoms before treatment experienced low efficiency at the end of the test phase.

Application and progress of neuromodulation in lower urinary tract dysfunction / 生物医学工程学杂志

For those patients with refractory lower urinary tract dysfunction who are not well treated by traditional therapy such as behavior therapy and drug therapy, neuromodulation technologies have gradually become alternative treatments. Several neuromodulation technologies are also used in animal experimental and clinical scientific research by more and more scholars, in order to find more effective methods and mechanisms of treatment of lower urinary tract dysfunction. This article introduces the principle and advantages of common neuromodulation technologies, which focuses on the application in lower urinary tract dysfunction treatment, and analyzes the direction and the broad prospect of neuromodulation.

Needle Placement: A Guide to Predictable Sensory and Motor Responses Based on Variations in Needle Placement During Sacral Neuromodulation Procedures / 대한배뇨장애요실금학회지

PURPOSE: Providing practitioners with an adjunctive guide that will aid implanters in the ability to predict and, immediately recognize, what suboptimal needle placement looks like (based on visualization of needle/lead placement and the patient's sensory and motor responses), allow cultivation of a more complete and comprehensive level of understanding of the sacral neuromodulation procedure as a whole, and inversely provide a guide for what true optimal needle/lead placement should currently demonstrate (based on current International Continence Society guidelines).METHODS: More than 400 patients underwent sacral neuromodulation procedures from 2011–2018 by a practitioner who is in the top 5% of implanting physicians in the United States. Common stimulation patterns with motor and sensory responses were observed in patients with suboptimal needle placement intraoperatively.RESULTS: Reproducible stimulation patterns were observed with common suboptimal needle placement intraoperatively. This allowed the implanting practitioner to immediately identify and correct the needle placement intraoperatively to achieve optimal needle placement and optimal motor and sensory responses for the patients.CONCLUSIONS: By considering the 3-dimensional spatial trajectory of the S3 nerve, and following this presented guide, the most optimal lead placement with consistently reproducible outcomes that include S3 motor and sensory response on all 4 leads at less than, or equal to, 2 volts can be achieved and can potentially maximize the life of the device while potentially affording patients a more successful outcome.

Do Failure of Posterior Tibial Nerve Stimulation Precludes to Use Sacral Neuromodulation in Patient With Overactive Bladder? / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the outcomes of sacral neuromodulation (SNM) after failure of transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with overactive bladder (OAB).METHODS: A retrospective study was conducted in 3 university hospitals and included all patients with OAB and treated with SNM after TPTNS had been tried between October 2008 and May 2018. The primary endpoint was the proportion of definitive SNM device implantation in patients with 50% objective and/or subjective improvement after a test period (stage 1). The secondary outcomes of interest were changes of the number of diurnal voids and nocturia episodes per 24 hours between the end of TPTNS and the end of stage 1.RESULTS: Overall, 28 of the 43 patients included achieved at least 50% objective and/or subjective improvement during stage 1 and underwent an Interstim II implantation (65.1%). The mean daytime frequency decreased significantly from 10.3/day at the end of TPTNS to 7.8 diurnal voids/day at the end of SNM stage 1 (P=0.01). The mean number of nocturia episodes decreased from 2.5/night at the end of TPTNS to 2.1/night at the end of stage 1, but this did not reach statistical significance (P=0.18). There was no other parameter significantly associated with response to SNMCONCLUSIONS: SNM might improve OAB symptoms in most patients who experienced no or poor efficacy with TPTNS. History of failed TPTNS should not preclude the use of SNM in OAB patients.

Analysis of efficiency of sacral neuromodulation in the treatment of non-neurogenic and non-obstructive dysuria in elderly patients / 中华老年医学杂志

Objective To evaluate the effectiveness and safety of sacral neuromodulation(SNM) in the treatment of non-neurogenic and non-obstructive dysuria in elderly patients.Methods Six elderly patients with non-neurogenic and non-obstructive(2 males and 4 females)treated with SNM were recruited from multiple medical centers across the country in this retrospective study from January 2012 to December 2016.All patients received two or more conservative treatments including behavior therapy,oral therapy,etc.,with no good effect.Data of the average residual urine volume,average urine volume,maximum urine volume,average urinary frequency and quality of life score before operation,after implantation of stage Ⅰ tined lead,and at the end of follow-up after implantation of stage Ⅱ implanted pulse generator(IPG) were compared.Results The average age in the 6 patients was 69.5 (65 ～ 79) years.The results of SNM treatment showed that the objective findings and/or subjective symptoms in all patients were significantly improved in more than 50％ of indexes before treatment.All patients chose embedding of IPG at the end of stage Ⅰ,with 100.0％ of the conversion rate from stage Ⅰ to stage Ⅱ.The curative effect was stable in general.At stages of baseline,personal experience and end of follow-up respectively,the average residual urine volumes were (161.7±110.2)ml,(70.0±52.2) ml,and(50.0±44.7)ml,the average urine volume were(105.0± 74.0)ml,(163.3 ± 93.1) ml,and (155.0 ± 92.3) ml,and the maximum urine volume were (146.7 ± 81.2) ml,(216.7 ± 93.1) ml,and (206.7 ± 112.7) ml,which showed continuously significant improvements with patients' great satisfaction.The mean duration of fellow-up in 6 cases was 17.5 months(7-57 months).No severe adverse reactions such as wound infection,electrode dislocation and hematoma were observed.Conclusions SNM treatment is safe and effective for elderly patients with non-neurogenic and non-obstructive dysuria who are refractory to other treatments.SNM has a stable medium-term curative effect and a high-transfer-rate from stage Ⅰ to stage Ⅱ,which is appropriate for non-neurogenic and non-obstructive dysuria.The duration of SNM may be positively correlated with the improvement of residual urine volume and urination frequency.

Analysis of efficiency of sacral neuromodulation in the treatment of non-neurogenic and non-obstructive dysuria in elderly patients / 中华老年医学杂志

Objective@#To evaluate the effectiveness and safety of sacral neuromodulation(SNM)in the treatment of non-neurogenic and non-obstructive dysuria in elderly patients.@*Methods@#Six elderly patients with non-neurogenic and non-obstructive(2 males and 4 females)treated with SNM were recruited from multiple medical centers across the country in this retrospective study from January 2012 to December 2016.All patients received two or more conservative treatments including behavior therapy, oral therapy, etc., with no good effect.Data of the average residual urine volume, average urine volume, maximum urine volume, average urinary frequency and quality of life score before operation, after implantation of stage Ⅰ tined lead, and at the end of follow-up after implantation of stage Ⅱ implanted pulse generator(IPG)were compared.@*Results@#The average age in the 6 patients was 69.5(65~79)years.The results of SNM treatment showed that the objective findings and/or subjective symptoms in all patients were significantly improved in more than 50% of indexes before treatment.All patients chose embedding of IPG at the end of stage Ⅰ, with 100.0% of the conversion rate from stage Ⅰ to stage Ⅱ.The curative effect was stable in general.At stages of baseline, personal experience and end of follow-up respectively, the average residual urine volumes were(161.7±110.2)ml, (70.0±52.2)ml, and(50.0±44.7)ml, the average urine volume were(105.0±74.0)ml, (163.3±93.1)ml, and(155.0±92.3)ml, and the maximum urine volume were(146.7±81.2)ml, (216.7±93.1)ml, and(206.7±112.7)ml, which showed continuously significant improvements with patients' great satisfaction.The mean duration of fellow-up in 6 cases was 17.5 months(7-57 months). No severe adverse reactions such as wound infection, electrode dislocation and hematoma were observed.@*Conclusions@#SNM treatment is safe and effective for elderly patients with non-neurogenic and non-obstructive dysuria who are refractory to other treatments.SNM has a stable medium-term curative effect and a high-transfer-rate from stage Ⅰ to stage Ⅱ, which is appropriate for non-neurogenic and non-obstructive dysuria.The duration of SNM may be positively correlated with the improvement of residual urine volume and urination frequency.

Application of computer-assisted 3D printing techniques in electrode placement during sacral neuromodulation / 第二军医大学学报

Objective: To explore the application and efficacy of 3D printing technology of computed tomography 3D reconstruction and computer-assisted design in sacral neuromodulation. Methods: This is a randomized, controlled, prospective study. From March 2017 to March 2018, 15 candidates for sacral neuromodulation were randomized into traditional puncture group (n=10) and 3D printing group (n = 5). X-ray guided electrode placement was used in the traditional puncture group, and 3D printing navigation template puncture was applied in the 3D printing group. The clinical efficacy of the two groups was evaluated. Puncture time, needle insertion times, intraoperative adjustment and testing time, and postoperative complications (such as wound bleeding, wound infection, wound dehiscence, electrode breakage, displacement or prolapse) were assessed. Results: There were no significant differences in gender, age, sacral neural foramen size, sacrococcygeal deformity, or disease type between the two groups (all P>0.05). Compared with those in the traditional puncture group, the puncture time, needle insertion times, intraoperative adjustment and testing time were significantly decreased in the 3D printing group ([9.10 ± 2.73] min vs [26.20 ± 5.67] min, 3.20 ± 0.84 vs 5.30±1.30, [20.80 ± 3.27] min vs [27.60 ± 4.63] min; t=6.301, 3.255, 2.916; all P<0.05). Complications such as wound infection, wound bleeding, wound dehiscence, electrode breakage, displacement or prolapse, or pain of stimulator, were not found after operation. Conclusion: Compared with traditional method, computer-assisted 3D printing technology is safe in sacral neuromodulation. It can reduce the needle insertion times, shorten the puncture time, and improve the efficiency of intraoperative adjustment and testing.

Success and Complication Rates After Sacral Neuromodulation for Fecal Incontinence and Constipation: A Single-center Follow-up Study

BACKGROUND/AIMS: The aim of this study was to evaluate the sustainability of sacral neuromodulation (SNM) success in patients with fecal incontinence (FI) and/or constipation. METHODS: This is a retrospective analysis of a prospective database of patients who received SNM therapy for FI and/or constipation between 2006 and 2015. Success rates, complications and reintervention rates were assessed after up to 10 years of follow-up. RESULTS: Electrodes for test stimulation were implanted in 101 patients, of whom 79 (78.2%) received permanent stimulation. The mean follow-up was 4.4 ± 3.0 years. At the end of follow-up, 57 patients (72.2%) were still receiving SNM. The 5-year success rate for FI and isolated constipation was 88.2% (95% confidence interval [CI], 80.1–97.0%) and 31.2% (95% CI, 10.2–95.5%), respectively (P 50% in 76.1% of patients (95% CI, 67.6–86.2%) after 5 years. A lead position at S3 was associated with an improved outcome (P = 0.04). Battery exchange was necessary in 23 patients (29.1%), with a median battery life of 6.2 years. Reinterventions due to complications were necessary in 24 patients (30.4%). For these patients, the 5-year success rate was 89.0% (95% CI, 75.3–100.0%) compared to 78.4% (95% CI, 67.2–91.4%) for patients without reintervention. CONCLUSIONS: SNM offers an effective sustainable treatment for FI. For constipation, lasting success of SNM is limited and is thus not recommended. Reinterventions are necessary but do not impede treatment success.

Effects of Acute Sacral Neuromodulation at Different Pulse Widths on Bladder Overactivity in Pigs / 대한배뇨장애요실금학회지

PURPOSE: Sacral nerve stimulation has been used to treat overactive bladder. This study evaluated the effects of stimulation using different pulse widths on the inhibition of bladder overactivity by sacral nerve stimulation (SNM) in pigs. METHODS: Implant-driven stimulators were used to stimulate the S3 spinal nerve in 7 pigs. Cystometry was performed by infusing normal saline (NS) or acetic acid (AA). SNM at pulse widths of 64 μsec to 624 μsec was conducted at the intensity threshold at which observable perianal and/or tail movement was induced. Multiple cystometrograms were performed to determine the effects of different pulse widths on the micturition reflex. RESULTS: AA-induced bladder overactivity reduced the bladder capacity to 46.9%±7.1% of the NS control level (P0.05). The actual intensity threshold varied from 0.7 to 8 V. The mean intensity threshold (T visual) for pulse widths of 64 μs, 204 μs, and 624 μs were 5.64±0.76 V, 3.11±0.48 V, and 2.52±0.49 V. T visual for pulse widths of 64 μsec was larger than the other two T visual for pulse widths of 204 μsec and 624 μsec (P0.05). CONCLUSIONS: This study indicated that different pulse widths could play a role in inhibiting bladder overactivity. It is not yet certain which pulse widths increased bladder capacity compared with AA levels, to minimize energy consumption and maintain patient comfort during stimulation, 204 μsec may be an appropriate pulse width for SNM.

Outcomes of Intradetrusor Onabotulinum Toxin A Therapy in Overactive Bladder Refractory to Sacral Neuromodulation / 대한배뇨장애요실금학회지

PURPOSE: Intradetrusor onabotulinum toxin A (BTXA) and sacral neuromodulation (SNM) are effective third-line therapies for overactive bladder (OAB). We aimed to measure the outcomes of BTXA for treatment of OAB refractory to initial SNM and identify patient characteristics associated with these outcomes. METHODS: This retrospective cohort study included patients who failed to respond to initial SNM treatment for OAB and subsequently received BTXA at a single provider’s clinic between January 2013 and December 2016. Treatment successes were defined as patients willing to continue BTXA or who found symptom relief whereas treatment failures discontinued BTXA due to adverse effects or lack of symptom relief. Symptoms and patient-reported outcomes on validated questionnaires were compared before the initial BTXA trial to 2 months after the last BTXA treatment. The SNM failure BTXA groups were also compared to BTXA SNM naïve groups. RESULTS: Of 18 patients who received BTXA after failed SNM treatment, 7 (39%) achieved treatment success. Successfully treated patients demonstrated decreased urinary frequency from a median 11 voids/day pre-BTXA to 8 voids/day with BTXA (P=0.042). Patients whose treatment failed reported increased complaints of a weak urinary stream (P=0.03) and higher frequency of straining to urinate (P=0.016) than the successful treatment group pre-BTXA. Compared to BTXA patients without prior SNM, the odds of failing BTXA after initial SNM were 3.6 times higher (P=0.016). CONCLUSIONS: BTXA appears effective for OAB refractory to SNM, although the success rate is lower compared to BTXA patients without SNM exposure.

Research progress of sacral neuromodulation procedure in the treatment of chronic constipation and fecal incontinence / 中华胃肠外科杂志

Sacral neuromodulation (SNM) procedure has become a new therapy to treat chronic constipation and fecal incontinence. The surgical procedure is easy and safe. It has a small incision compared with traditional surgery and is mainly used in patients whose traditional treatment was unsuccessful. Chronic constipation is one of the most common digestive symptoms. The quality of life in patients with severe constipation has decreased greatly. Although the incidence of fecal incontinence in China is not as high as that of constipation, it also seriously affects the life of the patients, resulting in a decline in the quality of life. Although the mechanism of SNM is uncertain, with more studies conducted, understanding has become more profound, and the curative effect has been recognized. SNM can improve the symptoms and the quality of life. Many studies have reported SNM treatment. Furthermore, some trials on SNM have been conducted. It is used after colorectal resections to promote symptoms of bowel dysfunction. However, few studies reported regarding SNM for constipation and fecal incontinence in China, and knowledge regarding SNM is limited. In this article, we will mainly discuss SNM in the treatment of chronic constipation and fecal incontinence, and its research progress on the mechanism and method, surgical procedure, effectiveness, complications, postoperative contraindications, and the population who need to pay attention, in order to provide reference for the treatment of SNM in China.