多学科协作模式在卒中后神经源性膀胱患者管理中的应用

目的探讨多学科协作模式在卒中后神经源性膀胱患者管理中的应用效果。方法选取2018年1月至2019年12月入住中山大学附属第五医院神经内科卒中后神经源性膀胱患者160例为研究对象,将2018年1月至2018年12月入院的71例患者设为对照组;2019年1至2019年12月入院的89例患者设为观察组,对照组采用常规护理模式,观察组在常规护理的基础上开展多学科协作膀胱管理团队干预,比较两组患者的尿路感染、膀胱功能恢复情况、平均留置导尿管时间及护理满意度。结果观察组患者尿路感染发生率6.74%,低于对照组的29.58%;平衡膀胱有效建立率68.53%,高于对照组的30.98%;平均留置导尿管时间(4.84±1.62)d,低于对照组(9.76±3.72)d;患者满意度为96.62%(86/89),高于对照组的70.42%(50/71),差异均具有统计学意义(P0.05)。结论多学科协作模式可有效降低患者尿路感染的发生,促进膀胱功能的恢复,明显缩短留置导尿管时间,提高患者满意度,值得临床推广应用。     

磁共振骶神经成像联合3D打印在伴特殊合并症的神经源性膀胱患者骶神经调节术中的应用效果

本文探讨了磁共振骶神经成像联合3D打印技术在伴特殊合并症的神经源性膀胱患者骶神经调节术中的应用效果。共纳入21例特殊合并症神经源性膀胱患者, 随机分为2组:对照组采用传统X线透视下十字定位法结合体表骨性标志定位法, 试验组采用磁共振骶神经成像联合3D打印技术法辅助定位穿刺。结果显示试验组C臂透视次数、穿刺进针次数、穿刺所需时间、术中调节测试时间较对照组更低, Ⅱ期永久刺激器植入转换率更高。     

混合现实技术在青少年神经源性膀胱患者健康教育中的应用

目的 探讨基于混合现实技术的液体管理健康教育在青少年神经源性膀胱患者中的应用效果。 方法 将80例青少年神经源性膀胱患者随机分为干预组和对照组各40例。对照组使用宣教册进行常规液体管理健康教育,干预组采用混合现实技术进行液体管理健康教育。比较两组液体管理依从性、自我管理水平、出院后2个月内泌尿系感染发生率及患者监护人满意度。 结果 干预后,干预组液体管理依从性、自我管理得分及患者监护人满意度显著高于对照组（均P＜0.05）;干预组出院后2个月内泌尿系感染发生率为20.00%,较对照组低（27.50%）,但差异无统计学意义（P＞0.05）。 结论 基于混合现实技术的健康教育有助于改善青少年神经源性膀胱患者健康相关行为和提高监护人的满意度,相对减少出院2个月内泌尿系感染。     

神经源性膀胱患者住院健康教育路径的制订与实施

目的探讨健康教育路径管理在神经源性膀胱患者实施间歇性导尿中的应用效果。方法将60例脊髓损伤致神经源性膀胱患者随机分为对照组和观察组各30例,对照组采用常规健康教育方法,观察组应用健康教育路径表实施健康教育,于出院前1周评价效果。结果观察组患者健康知识掌握程度、护理满意度及膀胱管理的依从性显著优于对照组(P0.05,P0.01)。结论针对神经源性膀胱患者制定健康教育路径并实行有效管理,可提高健康教育效果,从而提高患者自护依从性,有利于改善患者预后。     

骶神经调控术中不同疾病的参数设置研究

目的:探讨骶神经调控术(SNM)中不同疾病的参数设置对疗效的影响评价。方法:回顾性分析我院2016年3月～2018年12月117例接受SNM第二阶段永久刺激器植入术患者的临床资料。按疾病种类将患者分为四组,即膀胱过度活动症组(n=9)、盆腔疼痛组(n=31)、神经源性膀胱组(n=66)及排尿困难组(n=11)。统计分析四组患者年龄、性别、电极放置情况、刺激模式及第一阶段测试中最优化的电压、脉宽、频率等参数。结果:膀胱过度活动症组、盆腔疼痛组、神经源性膀胱组和排尿困难组患者年龄分别为(51.11±14.09)岁、(57.62±14.13)岁、(53.36±22.42)岁和(55.09±19.42)岁;膀胱过度活动症组男1例,女8例;盆腔疼痛组男13例,女18例;神经源性膀胱组男34例,女32例;排尿困难组男7例,女4例。第一阶段最优化的膀胱过度活动症组、盆腔疼痛组、神经源性膀胱组和排尿困难组电压分别为(1.91±1.56)V、(1.22±0.54)V、(1.47±0.81)V和(1.38±0.76)V,四组比较差异无统计学意义(P0.05);植入后脉宽分别为(262.50±81.37)μs、(270.00±68.68)μs、(286.15±65.83)μs和(265.00±77.78)μs,四组比较差异无统计学意义(P0.05);植入后频率分别为(11.87±5.41)Hz、(19.20±13.10)Hz、(29.79±9.51)Hz和(20.50±10.11)Hz,四组比较差异有统计学意义(P0.01)。结论:神经源性膀胱患者在频率方面明显高于膀胱过度活动症、盆腔疼痛及排尿困难患者,四组患者在电压及脉宽方面并无显著差异。今后SNM测试中可适当增加神经源性膀胱患者的频率,使患者能达到更好的疗效。     

阶段评估在神经源性膀胱康复护理中的实施

目的探讨阶段评估在脊髓损伤神经源性膀胱康复护理中的应用与效果。方法将124例脊髓损伤神经源性膀胱患者按时间段分为对照组52例、观察组72例,对照组行常规康复护理;观察组自行设计膀胱护理评估表进行阶段评估,根据评估结果采取相应的护理措施。于出院前1周评价效果。结果观察组达到平衡膀胱率及膀胱控制能力评分显著优于对照组(均P0.05)。结论采用膀胱护理评估表进行阶段评估有利于及时发现膀胱护理中的问题和采取有效的针对性干预措施,从而提高神经源性膀胱康复效果。     

神经源性膀胱尿道功能障碍患者的影像尿动力学研究

目的 探讨各类神经源性膀胱患者的影像尿动力学特点.方法 2002年12月至2008年6月间,我们对1800例神经源性膀胱患者进行了影像尿动力学检查,分析不同神经病变所致膀胱尿道功能障碍的影像学特点.结果 脑卒中患者均未发现上尿路改变和反流,71% 为逼尿肌过度活动(DO),60% 伴括约肌无抑制性松弛,29% 为逼尿肌无反射(DA).脑外伤患者中70% 为DO不伴协同失调.7例帕金森病患者均表现为DO.1170例骶上损伤患者91% 为DO,83% 伴逼尿肌括约肌协同失调(DSD),223例骶髓及以下损伤患者73% 为DA.共有12% 的创伤性脊髓损伤患者出现上尿路积水改变,4% 表现为膀胱输尿管反流.脊髓发育不良患者81% 表现为逼尿肌无反射,86% 膀胱顺应性下降,55% 有上尿路积水改变,31% 出现膀胱输尿管反流.腰椎间盘突出患者92% 为逼尿肌无反射,88% 膀胱顺应性基本正常.糖尿病膀胱患者81% 膀胱感觉减退,76% 排尿期逼尿肌收缩力低下.结论 不同神经病变所致神经源性膀胱尿道功能障碍的特点不同,应根据影像尿动力学检查结果 选择合适的临床治疗方案.     

AUA 2023热点速递：神经源性排尿功能障碍研究进展

2023年美国泌尿外科协会(AUA)年会于4月28日—5月1日在美国芝加哥举行。神经源性排尿功能障碍领域揭晓了突破性研究,本文就功能性泌尿外科人工智能应用、神经源性膀胱尿路感染预防、脊髓损伤患者膀胱管理、阴部神经调节在脊柱裂患者中的应用、肉毒毒素在神经源性下尿路功能障碍患者中的长期使用结果、“MONTI”重建术在成人神经源性膀胱中的术后结果等做简单介绍。     

1例永久性骶神经刺激器植入病人的护理

神经源性膀胱是由调节排尿功能的中枢神经或周围神经系统受到损害而引起的排尿功能障碍[1] 。近年来国外采用永久性骶神经刺激器 (ＩｎｔｅｒＳｔｉｍ ,ＩＳ)植入术治疗 ,其机制为定时、定量发放电脉冲 ,由骶3(Ｓ3)神经传导到其支配的膀胱壁上 ,调节、平衡膀胱逼尿肌功能 ,从而抑制膀胱壁过强收缩 ,或促进逼尿肌收缩功能不全的膀胱收缩 ,使异常的膀胱排尿功能得以纠正 ,由病人主观控制排尿。 2 0 0 1年 1月我科成功地实施ＩＳ植入术 1例 ,效果良好 ,报告如下。1　病例简介男 ,4 8岁。因尿频 ,不能自主控制排尿 1年 ,于2 0 0 1年 1月 7日入院…     

骶神经调控术在小儿神经源性膀胱治疗中的应用进展

小儿神经源性膀胱(PNB)是指脊髓发育不良、脊髓神经损伤导致膀胱逼尿肌或(和)尿道括约肌功能障碍，表现为排尿障碍或伴有排便障碍，严重影响患者的生活质量。骶神经调控(SNM)的主要适应证是膀胱过度活动综合征，症状包括顽固性尿频、尿急、急迫性尿失禁、非梗阻性尿潴留，推荐SNM的适宜年龄为16岁以上。研究表明SNM对改善顽固性膀胱功能和排便功能障碍效果显著。本文就骶神经调控在小儿神经源性膀胱治疗中的应用进展进行回顾，为该项技术在小儿神经源性膀胱人群中的开展提供参考。     

神经调节治疗神经源性排便功能障碍

目的 探讨神经调节技术治疗脊髓损伤后神经源性排便障碍的临床疗效.方法 2006年1月至2008年4月,我们应用神经调节技术治疗脊髓损伤后便秘9例,其中应用S3骶神经调节治疗1例,阴茎或阴蒂背神经调节治疗8例,通过Wexner便秘评分评价疗效.结果 1例患者接受骶神经调节治疗后,便秘症状明显改善,Wexner便秘评分从术前平均22分降低到术后平均9分.4例患者接受阴茎或阴蒂背神经调节治疗后有效,调节前Weber便秘评分平均19分,接受12周的阴茎或阴蒂背神经调节后Weber评分降低到平均11分.随访期问患者便秘症状及生活质量持续改善.结论 神经调节技术可以改善部分神经源性排便障碍患者的便秘症状,但目前尚无有效指标能够预测神经调节治疗神经源性排便障碍的效果,此项技术仍需要高质量的大样本随机对照研究来确证其治疗神经源性排便障碍的有效性.     

Neuromodulation and the neurogenic bladder

Neurogenic bladder resulting from spinal cord injury and spina bifida has a profound impact on voiding function. This article reviews the current literature with regards to electrical stimulation for neurogenic bladder and the clinical outcomes associated with sacral neuromodulation, pudendal neuromodulation, posterior tibial nerve stimulation, and the Finetech-Brindley posterior/anterior stimulator. In addition, the world literature reviewing hemilaminectomy and ventral root micro anastomosis is discussed. The article also examines the safety of magnetic resonance imaging in patients with implanted neurostimulators and discusses common complications. Neuromodulation, both electrical and physical, play an important role in the management of neurogenic bladder.     

Current and future techniques of neuromodulation for bladder dysfunction

Recent increase in the use of neuromodulation for the treatment of urinary urgency and frequency, urge incontinence, and nonobstructive urinary retention has coincided with improved knowledge of micturition physiology and concurrent technologic advances in nerve stimulation. Currently, the most common technology for bladder neuromodulation involves stimulation through the S3 foramen, or sacral neuromodulation, although other techniques of neuromodulation continue to be explored. Despite many advances in neuromodulation, the exact mechanism of action remains uncertain. Additionally, which patients will respond to neuromodulation remains unclear, and although there is a standard method for testing, this procedure is invasive and expensive. As we continue to improve patient selection criteria and better understand the mechanism of action, the efficacy and patient satisfaction should continue to increase. Currently, most patients considered for implantation with a neuromodulator are those unresponsive to other conservative treatments for bladder dysfunction.     

Neuromodulation in neurogenic bladder

While neuromodulation is a well-established treatment option for patients with non-neurogenic overactive bladder and urinary retention, its applicability to the neurogenic bladder population has only recently been examined more in depth. In this article we will discuss the outcomes, contraindications, and special considerations of sacral and percutaneous tibial nerve stimulation (PTNS) in patients with neurogenic lower urinary tract dysfunction.     

The Role of Neuromodulation in Patients with Neurogenic Overactive Bladder

To review the treatment options for patients with neurogenic overactive bladder (OAB), specifically the use of sacral neuromodulation (SNM). A search was performed on the available literature on SNM and lower urinary tract dysfunction. Based on published studies available and also on personal experience, the treatment options for neurogenic OAB are reviewed, and specifically, the role for SNM in these patients is discussed. SNM is FDA-approved for patients with urge incontinence, urgency/frequency, and non-obstructive urinary retention. It involves stimulation of the third sacral nerve with an electrode implanted in the sacral foramen and connected to a pulse generator. The procedure is minimally invasive and is effective in about 70?% of patients who have a permanent system. The original trials leading to the approval of SNM excluded patients with neurogenic disease, as it was felt that intact spinal pathways were necessary for neuromodulation to occur. However, similar success rates have been observed in patients with neurogenic OAB. Special considerations for SNM use in patients with neurogenic OAB include recognizing that it is incompatible for patients who will need MRI's due to their progressive neurologic disease. Many treatment options are available for patients with neurogenic OAB. First-line approaches remain conservative with lifestyle changes and anticholinergic medications. SNM has been used successfully in this patient population with good results, though larger randomized trials are lacking.     

骶神经调节治疗慢性排尿功能障碍二例报告

目的　探讨骶神经调节治疗慢性排尿功能障碍的疗效与安全性。　方法　采用骶神经调节技术治疗 2例慢性排尿功能障碍患者 ,通过排尿日记和症状改善评价疗效。　结果　经皮穿刺测试结果表明 :例 1患者每日排尿次数降低 7.3% ,排尿量增加 118.2 % ,尿急程度减轻 72 .0 % ;例 2患者排尿次数降低 34.3% ,排尿量增加 6 5 .7% ,尿急程度减轻 6 8.1%。 2例分别随访 2 6和 17个月 ,各项排尿参数持续改善 ,例 1排尿次数减少 4 6 .8% ,排尿量增加 4 5 .3% ,尿急程度减轻 6 7% ;例 2排尿次数减少 39.7% ,排尿量增加 6 5 .6 % ,尿急程度减轻 86 %。随访期未发现并发症。　结论　骶神经调节是一种创伤小、安全、有效治疗慢性排尿功能障碍的方法 ,对某些神经原性膀胱尿道功能障碍有一定疗效。     

Chronic sacral neuromodulation for treatment of neurogenic bladder dysfunction: long-term results with unilateral implants

Objectives. To investigate the therapeutic value of sacral neuromodulation in patients with neurogenic disorders in whom conservative treatment options were unsuccessful. Neurogenic disorders may result in various forms of lower urinary tract dysfunction.Methods. Twenty-seven patients (19 women, 8 men) aged 18 to 63 years (mean 44.9 years) were subjected to percutaneous test stimulation of the sacral spinal nerves. Their urologic symptoms consisted of bladder storage failure (n = 15) due to detrusor hyperreflexia and/or bladder hypersensitivity, failure to empty due to detrusor areflexia (n = 11), and combined bladder hypersensitivity and detrusor areflexia (n = 1). Twelve patients (11 women and 1 man) underwent chronic sacral neuromodulation with unilateral electrode implantation into one of the dorsal S3 foramina. The follow-up was 89.3 months (range 13 to 126).Results. Severe side effects were encountered in 2 patients (1 with infection and 1 with adverse sensation during stimulation) and moderate side effects in another 3 patients. In 1 patient, the implant had to be removed during the immediate postoperative period. In 3 patients, the implant was not effective. In 8 patients, the symptoms of lower urinary tract dysfunction were significantly attenuated (50% or more) for 54 months (range 11 to 96). After this period, all implants became ineffective, except one, which was still in use at the last follow-up visit.Conclusions. Unilateral chronic sacral neuromodulation using sacral foramen electrodes can be a valuable, but only temporary, treatment for neurogenic bladder dysfunction. The technique of chronic sacral neuromodulation should be refined to achieve the same and lasting results with implantation systems as achieved with preoperative test stimulation.     

手术室医护一体化综合管理措施在烧伤患者中的应用效果

目的 分析手术室医护一体化综合管理措施在烧伤患者中的应用效果。方法 选取我院2020年 1月-2021年12月收治的94例烧伤手术患者为研究对象,以随机数字表法分为对照组和试验组,每组47例。 对照组采用常规护理,试验组采用手术室医护一体化综合管理措施,比较两组生活质量、心理状态、满意 度、疼痛程度及不良事件发生情况。结果 试验组干预后生活质量各维度评分均高于对照组（P＜0.05）; 试验组干预后SAS评分、SDS评分及VAS评分均低于对照组（P＜0.05）;试验组满意度为100.00%,高于对 照组的82.98%（P＜0.05）;试验组不良事件发生率为0,低于对照组的14.89%（P＜0.05）。结论 手术室医 护一体化综合管理措施在烧伤患者中的应用效果确切,可有效提高临床护理效果,有利于减轻患者疼痛, 改善其心理状况,降低不良反应发生风险,且患者满意度较高。     

Sakrale Neuromodulation in der Urologie

Sacral nerve modulation (SNM) is an innovative, minimally invasive treatment that uses chronic low-level electrical stimulation of the sacral plexus to recruit residual physiological function of urinary bladder detrusor, pelvic floor muscles, and the anorectal continence structures. Classic indications for sacral neuromodulation in urology are refractory overactive bladder symptoms (urinary urgency ± incontinence) and chronic nonobstructive urinary retention. SNM also offers a therapeutic alternative in refractory chronic pelvic pain syndrome. The exact mechanism of action is still unknown, but it is assumed that electrical stimulation of the sacral nerves leads to neuromodulation as well as clinically beneficial effects in the pelvic floor, the sphincter complex, and the distal colorectum. SNM is a multistep procedure. In a test phase of so-called percutaneous or peripheral nerve evaluation (PNE), the effect of sacral neuromodulation is evaluated over days or weeks during which a bladder diary/pain protocol is kept. The predictive value of PNE is high, while morbidity and surgical trauma are low. The screening phase provided by PNE makes this technique unique and offers an ideal instrument for patient selection. After final implantation of the neurostimulator (InterStim II), the long-term success rate is over 60–90%. At our clinic, 42 patients underwent a PNE procedure between January 2009 and June 2010. Of these, 34 patients had a >50% success rate and had been implanted with the InterStim II device (80.9%). The success rates were 83% for overactive bladder and 89% for chronic retention (mean follow-up 7.8 months). In addition to the surgical procedure, the exact indication and postoperative care are important prerequisites of successful therapy. To date, no information on the number of implanted stimulators in Germany is available. This suggests the need for establishment of a national prospective registry. It would also be appropriate that the experts from the implantation centers form a working group.     

Non-invasive antidromic neurostimulation: a simple effective method for improving bladder storage

Patients with intractably diminished bladder storage function are encountered frequently by neurourologists, occasionally requiring reconstructive surgery for appropriate resolution. Although sacral neuromodulation is a recognized effective therapeutic modality, present techniques are technically demanding, invasive, and expensive. This study investigated the effect of non-invasive third sacral nerve (S3) stimulation on bladder activity during filling cystometry. One hundred forty-six patients underwent standard urodynamic filling cystometry that was then immediately repeated. Patients in the study group (n = 74) received antidromic transcutaneous sacral neurostimulation during the second fill and the control group (n = 72) underwent a second fill without neurostimulation. A statistically significant increase in bladder storage capacity without a corresponding rise in detrusor pressure was observed in the neurostimulated patients. This improvement in functional capacity is an encouraging finding that further supports the use of this non-invasive treatment modality in clinical practice.