Sacral neuromodulation with implanted devices for urinary storage and voiding dysfunction in adults

 

Abstract

Background

The neural control of storage and voiding of urine is complex and dysfunction can be difficult to treat. One treatment for people with refractory symptoms is continuous electrical nerve stimulation of the sacral nerve roots using implanted electrodes and an implanted pulse generator.

Objectives

To determine the effects of implantable electrical stimulation devices in the treatment of urine storage and voiding problems.

Search methods

We searched the Cochrane Incontinence Group Specialised Register (searched 10 February 2009), CENTRAL (The Cochrane Library 2008, Issue 1), MEDLINE (January 1980 to March 2008), EMBASE (January 1980 to March 2008), CINAHL (January 1982 to March 2008) and the reference lists of relevant articles.

Selection criteria

Trials that tested implanted electronic stimulators connected to electrodes attached to the nerves and providing continuous electrical stimulation for neuromodulation.

Data collection and analysis

Both authors selected studies, assessed quality, and extracted data.

Main results

Eight reports of randomised studies that evaluated implants which provided continuous stimulation were included. It was unclear whether some reports included patients who also appeared in other reports, so no data were pooled. In spite of this, it seems clear that continuous stimulation offers benefits for carefully selected people with overactive bladder syndrome and for those with urinary retention but no structural obstruction.

Many of the implants did not work and many required revision operations. Many questions remain about patient selection and the best way to use these devices.

Authors' conclusions

In spite of methodological problems, it would appear that some people benefit from implants which provide continuous nerve stimulation. More research is needed on the best way to improve patient selection, carry out the implant, and to find why so many fail. The effectiveness of implants should be tested against other interventions, particularly in people with an overactive bladder.

 

Plain language summary

Electrical stimulation of nerves with permanently implanted devices for adults with abnormal urine storage or voiding

Many people have urinary problems that are difficult to control by non-surgical means. Most surgical treatments are for people with stress incontinence only. Implants that provide continuous electrical stimulation to the nerves that control the bladder have been used in people with other types of incontinence. These devices are expensive, the surgery is invasive, and many people need another operation. It is not clear how best to use these devices. However, implantable stimulators that provide continuous electrical stimulation to the nerves or nerve roots supplying the bladder and pelvis, or to the peripheral nerves that share the same nerve roots, can benefit carefully selected patients with difficult-to-control urinary problems.

 

摘要

背景

使用植入裝置對成人尿液儲存或排空功能失調的薦骨神經調節

尿液儲存或排空的神經控制是複雜的，也因此排尿功能失常在治療上可能會遇到困難。其中一種對治療上有困難的症狀的方法是透過植入電極及脈衝產生器，對薦神經根產生連續的電神經刺激。

目標

決定電刺激產生器的植入對有尿液排空及儲存問題上的治療其影響及效益。

搜尋策略

搜尋的資料庫包括Cochrane Incontinence Group Specialised Register(至2009年2月10日)，CENTRAL(2008年Cochrane Library, Issue 1)，MEDLINE(自1980年1 月至2008年3月)，EMBASE(1980年1月至2008年3月)，CINAHL(1982年1月至2008年3月)及其相關文章。

選擇標準

所有囊括研究透過電流產生器植入而對神經產生連續刺激之文章。

資料收集與分析

評估其研究之品質及資料架構。

主要結論

共有8篇關於此方面的研究被分析。因不知在病人的收集方面是否在不同的研究有被重覆納入，因此沒有辦法做資料的統整。儘管如此，在特定的病人如膀胱過動症候群(overactive bladder syndrome)及有尿液滯留但無結構上的問題者，連續電流刺激均有所助益。另外也有相當數目的植入無顯著效果或是需要再次手術。這牽涉到病人挑選及使用上的最佳方法。

作者結論

雖然在資料的彙整上有困難，但目前研究顯示在一些患者可藉由植入連續神經電流產生器獲得助益。然而更多的研究是必須的，特別是在病人挑選，植入的執行及失敗機率仍偏高方面，而在與其他方法的比較也是必要的，特別是在膀胱過動症候群的病人。

翻譯人

本摘要由中國醫藥大學附設醫院張維君翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

許多有排尿問題的病人無法藉由非手術方法來改善。大部分手術治療只針對應力性失禁(Stress incontinence)的患者。而在另一些種類的失禁患者，植入連續神經刺激器來控制膀胱是可行的方法。然而目前最佳的使用方法仍不得而知。不過，植入電流刺激器來調控支配膀胱的神經、神經根或是由共同神經根分出的周邊神經，在特定且有難以解決之排尿問題的患者，將有助於症狀的緩解。