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林佑樺 骶骨和經皮脛骨神經調節對非神經源性下尿路功能障礙和慢性盆腔疼痛的療效和安全性:系統性論述文獻研究 2018/4/30 下午 03:32:06 0
原 文 題  目 Efficacy and Safety of Sacral and Percutaneous Tibial Neuromodulation in Non-neurogenic Lower Urinary Tract Dysfunction and Chronic Pelvic Pain: A Systematic Review of the Literature
作  者 Manuela Tutolo, Enrico Ammirati, John Heesakkers, Thomas M. Kessler, Kenneth M. Peters, Tina Rashid, Karl-Dietrich Sievert, Michele Spinelli, Giacomo Novara, Frank Van der Aa, Dirk De Ridder
出  處 European Urology, 73 (3), 406 - 418
出版日期 January 11, 2018
評 論

骶神經調節治療已經在美國食品和藥物管制局通過其適應症使用在膀胱過動症及慢性非阻塞性尿滯留的病患上,在過去幾年內中國大陸也有許多相關的研究並實際應用在臨床上,然而對於其效果及可能的副作用的程度,在之前的文獻中有非常大的分歧性,特別在預後情況、症狀評估工具、及神經調節治療前所接受的治療情況,都未達成共識而未曾被完整的整理探討,本文使用高證據性的系統性論述評估非神經性下泌尿道疾病患者,在接受神經調節治療後的六個月以上追蹤治療成效評估。

研究結果於最後分析共有21篇高品質的研究被收入系統性論述文獻研究中,其中29%至76%的病患在接受骶神經調節治療可以有效減少超過一半以上的急尿漏尿情況,而整體甚至有43%至56%的病人不會有漏尿情況,在經皮脛骨神經刺激治療則有54%至59%的成功或改善率,然而在間質性膀胱炎的成效在兩種神經調節治療則均明顯較差,在副作用的比較上則是經皮脛骨神經刺激治療有較低的副作用發生。根據此研究,我們可以確立在膀胱過動症及慢性非阻塞性尿滯留病患,使用神經調節治療是安全且為長效持續性的治療,其中又以經皮脛骨神經刺激治療相較於骶神經調節治療有更低的副作用發生情況,然而這僅限於短期的追蹤,而在長期的追蹤資料仍需要進一步的研究確立其結果。

abstract

Context: Neuromodulation is considered in patients with non-neurogenic lower urinary tract dysfunction (LUTD) not responsive to conservative treatment.

Objective: To systematically review the available studies on efficacy and safety of sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) in non-neurogenic LUTDs not responsive to conservative treatments.

Evidence acquisition: A literature research was conducted in PubMed/Medline and Scopus, restricted to articles in English, published between January 1998 and June 2017, with at least 20 patients and 6 mo of follow-up.

Evidence synthesis: Twenty-one reports were identified. Concerning SNM, the improvement of ≥50% in leakage episodes ranged widely between 29% and 76%. Overall dry rate ranged between 43% and 56%. Overall success/improvement rate in PTNS varied between 54% and 59%. Symptom improvement or efficacy in interstitial cystitis/bladder pain syndrome patients appeared to be lower compared with other indications in both techniques. Safety data showed fewer side effects in patients submitted to PTNS.

Conclusions: Neuromodulation gives good results and is a safe therapy for patients with overactive bladder or chronic nonobstructive urinary retention with long-lasting efficacy. Moreover, PTNS has been shown to have good success rates and fewer side effects compared with SNM. These data have to be confirmed with long-term follow-up.

Patient summary: Sacral neuromodulation can improve low urinary tract symptoms in selected patients; it appears to be a safe therapy for nonresponders to standard medical therapies. Percutaneous tibial nerve stimulation (PTNS) is a less invasive technique that gives good results in short time with fewer side effects. However, we must consider that PTNS has not been tested in the long term and results are lower if compared with SNM.

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