Clinical application of sacral nerve modulation in the treatment of interstitial cystitis/bladder pain syndrome
Objective To discuss the clinical effect of sacral nerve modulation in the treatment of interstitial cystitis/bladder pain syndrome.Methods A total of 8 patients with interstitial cystitis were retrospectively analyzed.These patients were treated in the First Affiliated Hospital of Anhui Medical University from June 2019 to March 2021,including 7 females and 1 male,aged from 42 to 72 years,with a median age of 58 years.The course of disease ranged from 6 months to 11 years,with an average of 39.6 months.All 8 patients were treated with antibiotics and M receptor blockers for more than 2 months without clinical effect.Four patients had a history of bladder hydrodistension,and two patients had received sodium hyaluronate perfusion treatment plus bladder hydrodistension.One patient had a history of botulinum toxin injection into bladder detrusor,sodium hyaluronate perfusion treatment and bladder hydrodistension.The 0'Leary-Sant scale assessed an average score of 34.00±1.93.The average pain visual analogue scale(VAS)score was 9.38±0.92.The average QOL score was(5.50±0.53)points.The average number of urinations within 24 hours before operation was(39.12±6.75)times,and the average nocturia was(15.87±5.14)times with the average urine volume of(51.62±16.51)ml.SNM electrode was placed into S3 under local anesthesia(SNM stage 1),and treated for 2-4 weeks after operation.The improvement of symptoms after sacral neuromodulation stage 1 was observed and recorded.Compared with pre-operation,if the symptoms of frequency,urgency and pain improved＞50％,the second-stage permanent stimulator implantation can be performed.Results Seven female patients were converted to secondary permanent stimulator implantation with an average conversion time of(41.71±22.48)days.One male patient was clinically ineffective and the stimulator was removed.The average number of urinations in 24 hours before operation,1 week after operation and 1 month after operation were(39.12±6.75)times,(17.71±3.40)times and(14.71±4.27)times respectively;while the average VAS score was(9.38±0.92 vs.2.71± 1.38 vs.2.29±1.11).The symptoms were improved significantly,and the difference was statistically significant.Frequent urination recurred on two female patients respectively at 3 months and 6 months after the secondary operation,and the symptoms were relieved after adjusting the frequency.The patients were changed to frequency conversion mode 1 year after operation,and were followed up for 3 months without recurrence.The improved symptoms in 5 patients who was in stage 2 and 2 patients who used frequency conversion mode after stage 2 were followed up for 3 and 6 months.The average number of urinations within 24 hours before operation,3 months after operation and 6 months after operation was(39.12±6.75)times,(12.57±4.40)times and(12.86±5.30)times respectively(P＜0.01).The VAS score before operation,3 months after operation and 6 months after operation was(9.38±0.92),(2.14±1.21)and(2.28±1.11)points respectively(P＜0.01),suggesting significant improvement of micturition symptoms and pain symptoms after operation.Conclusions Sacral nerve modulation demonstrates both short-term and long-term effect for interstitial cystitis/bladder pain syndrome,and it is a reliable treatment.
万方数据
维普
