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發表人 | 討論主題 | 發表時間 | 討論數 |
陳俞安 | 以經皮脛神經刺激作為第一線間質性膀胱炎/膀胱疼痛症候群之治療 | 2022/11/3 下午 08:00:57 | 0 |
原 文 | 題 目 | First-line treatment posterior tibial nerve stimulation in patients with interstitial cystitis/bladder pain syndrome |
作 者 | Sahin Kabay, Sibel Canbaz Kabay, Mehmet Sevim | |
出 處 | Cent European J Urol. 2021;74(2):208-214 | |
出版日期 | 5 JUNE, 2021 | |
評 論 |
間質性膀胱炎/膀胱疼痛症候群根據國際尿控醫學會以及歐洲泌尿科醫學會的定義為: 與膀胱相關的不適感,疼痛,壓力感並且合併排尿症狀例如急尿感,頻尿感且沒有發現感染,結石或者癌症等明顯的膀胱疾病源。此疾病在膀胱鏡可能會有異常地發現也可能無明顯異常。根據不同的研究,此病症可能影響大約0.8~3%的成年人,又以女性多於男性。目前的治療主要以治標為主,包含藥物(肌肉鬆弛劑,甲型阻斷劑或者抗發炎止痛藥),通過膀胱鏡的擴張術,或者是膀胱內灌注(玻尿酸,肉毒桿菌素)。當以上治療都失敗時可能就會考慮手術治療,如膀胱擴張術,人工膀胱或者是尿度繞道。 經皮脛神經電刺激是近年來泌尿科新興的治療方式之一。通過相同感覺神經的傳入去微調膀胱的行為,過去的研究在膀胱過動症的病人身上有顯著的治療效果。然而在間貭性膀胱炎的病人身上則較少有研究,大部分先前的研究是作為藥物治療失敗的後線直線性治療。 此研究使用經皮電刺激在39位間質性膀胱炎的病人身上作為第一線的治療,再經過12週的治療之後比起治療前日間的頻尿,急尿以及膀胱疼痛感都顯著的改善。顯示經皮電刺激對於以急尿/頻尿症狀為主的間質性膀胱炎病人,不願或者對於藥物無法忍受的病人可以作為一個治療的選項。醫師在門診也可以與病人共享醫療決策並且包含此治療選擇。 |
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abstract |
Introduction: The aim of this study was to determine the effects of first-line treatment posterior tibial nerve stimulation (PTNS), applied once a week for a 12 week period, as a treatment modality for patients with Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS).
Material and methods: A total of 39 female patients with IC/BPS were enrolled in the study. Patients had one 30-minute session of PTNS per week for 12 weeks and symptoms were assessed before and after the treatment sessions by the use of a voiding diary, visual analog scale (VAS) for pain, O'Leary-Sant interstitial cystitis symptom index (ICSI), and O'Leary-Sant interstitial cystitis problem index (ICPI). Results: The mean age of the patients was 38.9 ±7.1 years. The improvements in voiding diary parameters after 12 weeks of PTNS treatment were statistically significant compared to baseline but the changes in nocturia, and average voiding volume were not statistically significant. Mean parametric improvements after 12 weeks of PTNS treatment compared to baseline included a daytime frequency decrease by 3.8 voids daily, urgency episodes decrease by 4.7 episodes daily, nocturia decrease by 0.3 voids and voided volume improvement by a mean of 8.4 ml. The difference for ICSI, ICPI and VAS between baseline and the 12th week of PTNS treatment scores demonstrated statistically significant improvements in pain severity, symptom and problem index. Conclusions: The findings in this study demonstrated the improvements of voiding diaries, ICSI, ICPI and VAS scores in patients with IC/BPS after 12 weeks PTNS. PTNS treatment is a beneficial firs-line treatment option to IC/BPS symptom amelioration. |
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