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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 賴姿君 | 討論主題 比較不同「神經調控治療」治療膀胱過動症之成效 | 2022/12/6 下午 06:42:40 | 0 |
| 原 文 | 題 目 | Comparative Efficacy of Neuromodulation Technologies for Overactive Bladder in Adults: A Network Meta-Analysis of Randomized Controlled Trials |
| 作 者 | JiapengHuangPhD, YeFanPhD, KehongZhaoMM, ChunlanYangMD, ZiqiZhaoMM, YinChenMM, JiaenYangPhD, TingtingWangMD, YunQuMD, PhD | |
| 出 處 | Neuromodulation: Technolocy at the Naural Interface. 2022;Aug. | |
| 出版日期 | 18 August 2022. | |
| 評 論 |
近期治療膀胱過動症，保守治療以膀胱訓練、骨盆肌肉訓練、藥物治療等，有大部分病人在藥物治療上因副作用而停藥，而在神經調控治療的定位則是於保守治療無效後，相對容易的治療之一，屬於膀胱過動之病人的第二至第三線治療。 在治療膀胱過動症的病患，使用「神經調控治療」已有許多研究結果有明顯成效，但缺乏各種不同的神經調控治療互相比較的研究，此篇文章於網路上收錄21篇RCT(randomized controlled trials)文章，共1433位膀胱過動之病患，分別針對經皮脛神經電刺激(percutaneous tibial nerve stimulation, PTNS), 經皮脛神經電刺激(transcutaneous tibial nerve stimulation, TTNS), 陰道電刺激(vaginal electrical stimulation, VES), 薦椎神經刺激(sacral neuromodulation, SNM), 薦椎神經旁刺激parasacral stimulation (PS), 陰部神經調節 (pudendal neuromodulation)等和對照組做比較，分別看生活品質的改善、頻尿、急尿、尿失禁、夜尿、24小時護墊使用數量等等。 在交互比較下，呈現的結果是膀胱過動的患者對於薦椎神經刺激(sacral neuromodulation, SNM)的治療有最好的生活品質的改善，以及頻尿的改善。而急尿的症狀改善以及護墊使用數量，則是用經皮脛神經電刺激(percutaneous tibial nerve stimulation, PTNS；transcutaneous tibial nerve stimulation, TTNS)之治療為最佳。夜尿的改善，則無明顯差異。 對於神經調控治療的研究，仍缺乏副作用及耐受度的比較，以及更長期的效果、滿意度和成本效益等等。 |
|
| abstract |
Objective The aim of this study was to investigate the comparative efficacy of neuromodulation technologies for overactive bladder (OAB) syndrome in adults. Data Sources A computerized search was conducted of Cochrane Library, EMBASE, MEDLINE (via PubMed), Web of Science, CNKI, Wan Fang Data, and ClinicalTrials.gov up to April 21, 2022. Study Selection The search selected clinical trials with random allocation to percutaneous tibial nerve stimulation (PTNS), transcutaneous tibial nerve stimulation (TTNS), vaginal electrical stimulation (VES), sacral neuromodulation (SNM), parasacral stimulation (PS), pudendal neuromodulation, or placebo. Data Extraction The main outcomes were the voiding diary, OAB-related quality of life, and positive response rate. The Cochrane Risk of Bias tool (RoB 2.0) was used to assess the risk of bias of each included study, and the Grading of Recommendations Assessment, Development, and Evaluation tool was used to evaluate the overall evidence quality of key outcomes. Data Synthesis The study included 21 randomized controlled trials involving 1433 participants, and all trials were used for the meta-analysis. In the network meta-analyses, five of six neuromodulation technologies, including PTNS, TTNS, VES, SNM, and PS, were related to higher efficacy than the placebo. Ranking probability showed that SNM was the most efficacious therapy for improving OAB-related quality of life, urinary episodes, and urinary frequency. For urgency incontinence episodes and the number of pads, PTNS and TTNS were the most efficacious modalities, respectively. Conclusion Neuromodulation technologies, including PTNS, TTNS, VES, SNM, and PS, may be effective and safe solutions for OAB syndrome in adults. Moreover, SNM is the most efficacious regimen for OAB-related quality of life, urinary episodes, and urinary frequency. PTNS and TTNS are the most efficacious modalities for reducing urgency incontinence episodes and the number of pads, respectively. Future studies should pay more attention to the quality of study design and report, patients who may benefit the most from neuromodulation, and the long-term effect, cost-effectiveness, and satisfaction of neuromodulation. |
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