骶神经调节术联合功能锻炼治疗脊髓损伤后神经源性膀胱的疗效观察

目的 探讨骶神经调节术联合功能锻炼治疗脊髓损伤后神经源性膀胱(NB)的疗效。方法 选取2017年3月-2019年9月本院脊髓损伤后NB患者80例,依据随机数字表分为锻炼组(n=40)和术炼组(n=40),锻炼组给予功能锻炼治疗,术炼组在此基础上给予骶神经调节术,比较2组尿流动力学[排尿期最大尿流率(Qmax)、排尿期膀胱最大容量(VMCC)、充盈期膀胱压(Pves)、残余尿量(RUV)]、排尿功能(单次排尿量和排尿、夜尿、尿失禁次数)、疗效、生活质量。结果 锻炼组和术炼组治疗2个月后Qmax,VMCC、单次排尿量明显高于治疗前,而Pves,RUV和排尿、夜尿、尿失禁次数明显低于治疗前(P<0.05); 术炼组治疗2个月后Qmax,VMCC、单次排尿量明显高于锻炼组,而Pves,RUV和排尿、夜尿、尿失禁次数明显低于锻炼组(P<0.05); 术炼组治疗有效率明显高于锻炼组(P<0.05); 锻炼组和术炼组治疗1、2个月后生活质量评分明显高于治疗前,术炼组治疗1、2个月后生活质量评分明显高于锻炼组(P<0.05)。结论 骶神经调节术联合功能锻炼可有效改善脊髓损伤后NB患者尿流动力学及排尿功能,有利于提高疗效及生活质量。     

神经假体移植与神经源性膀胱

背景：脊髓损伤后由于神经传导通路中断,膀胱失去正常调控,经常出现尿潴留及肾损害,其膀胱功能重建一直是神经泌尿外科学研究的难点之一,神经假体移植被认为是重建其功能的有效手段。 目的：探讨近年来应用神经假体移植治疗脊髓损伤后神经源性膀胱的最新进展。 方法：应用计算机检索CNKI和springer数据库中1988-01/2009-12关于神经假体移植治疗神经源性膀胱的文章,在标题和摘要中以“神经假体,移植,治疗,神经源性膀胱,电刺激”或“Neuroprostheses, Implantion, Treat, Neurogenic bladder, Electrical stimulation”为检索词进行检索。选择文章内容与神经假体移植治疗神经源性膀胱相关并发表在权威杂志上。根据纳入标准选择44篇文章进行综述。 结果与结论：目前脊髓再生研究尚无重大进展的情况下,神经假体移植技术逐渐成为重建脊髓损伤后神经功能的主要手段。当前临床上治疗神经源性膀胱的神经假体有2种：一是Finetech-Brindley 膀胱系统,另一种是InterStim-Therapy膀胱系统。近年来4种新技术的开展将对神经假体治疗神经源性膀胱带来革命性变化：①阳极阻滞技术。②条件性电刺激。③注射型神经假体。④刺激阴部神经分支。     

膀胱功能训练对神经源性膀胱排尿障碍的疗效观察

目的 观察膀胱功能训练对神经源性膀胱排尿功能障碍的临床效果.方法 采用综合性膀胱功能训练方法治疗神经源性膀胱排尿功能障碍30例,并对患者最大排尿量、残余尿量、最大尿流率、膀胱压力进行测评.结果 30例患者中控尿明显改善12例,改善10例,8例无效,总有效率73.33%.结论 综合性膀胱功能训练能在一定程度上恢复膀胱控尿...     

物理治疗糖尿病神经源性膀胱患者的效果观察

目的：观察物理治疗对糖尿病神经源性膀胱患者的临床效果。方法随机选取2013‐10—2014‐10我院60例糖尿病神经源性膀胱患者,按照治疗方式不同分为对照组和试验组,每组各30例。对照组给予基础药物治疗,试验组给予物理治疗,比较2组治疗效果。结果试验组总有效率（80.00％）高于对照组（53.33％）,差异有统计学意义（ P＜0.05）。结论物理治疗对糖尿病神经源性膀胱患者的临床效果较好,可考虑合理范围内加以推广应用。     

任脉灸联合功能锻炼治疗骶上脊髓损伤后神经源性膀胱的临床观察

目的探讨任脉灸联合功能锻炼治疗骶上脊髓损伤(Suprasacral spinal cord injury,SSCI)后神经源性膀胱(Neurogenic bladder,NB)的临床效果。方法选取本院2019年1月-2021年3月收治的79例SSCI后NB患者,根据随机数字表法分为2组,对照组(n=39)接受功能锻炼治疗,研究组(n=40)接受任脉灸联合功能锻炼治疗;比较2组患者尿流动力学、排尿功能、国际前列腺症状评分表(I-PSS)评分。结果治疗后研究组充盈期膀胱压(Vesical pressure,Pves)、排尿后残留量(Post-voided residual volume,PVR)、汉化版国际前列腺症状评分表(International prostate symptoms scale,I-PSS)评分明显低于对照组,最大尿流率(Maximum flow rate,Q_max)、最大尿意膀胱容量(Volume cystometric capacity,VMCC)、单次排尿量明显高于对照组,排尿次数、尿失禁次数、夜尿次数明显少于对照组(P<0.05)。2...     

莫沙比利与酚妥拉明联合治疗糖尿病神经源性膀胱的疗效观察

目的 观察莫沙比利与酚妥拉明联合治疗糖尿病神经源性膀胱的疗效。方法 将50例糖尿病神经源性膀胱患者分 为治疗组25例(莫沙比利与酚妥拉明组),对照组25例(酚妥拉明组),二组均连续治疗2周。结果 治疗组有效率为96％。对 照组有效率为76％,治疗组优于对照组(P<0.05)。结论 莫沙比利与酚妥拉明联合应用,是治疗糖尿病神经源性膀胱有效方 法之一。     

综合性治疗脊髓损伤后神经源性膀胱的临床观察

目的观察综合性治疗脊髓损伤(SCI)后神经源性膀胱的临床疗效。方法采用药物治疗、导尿术、膀胱功能训练、生物反馈进行综合治疗SCI神经源性膀胱患者28例,通过排尿次数、膀胱容量、最大排尿量、残余尿量及国际LUTS症状指标观察治疗疗效。结果 28例脊髓损伤后神经源性膀胱患者在接受综合治疗后排尿次数、残余尿量显著减少,而膀胱容量增加,排尿症状、国际LUTS症状评分显著改善,差异均具有统计学意义(P0.05)。结论脊髓损伤后神经源性膀胱患者采用综合性治疗方法能够改善排尿功能,达到提高生存质量的目的。     

神经源性膀胱尿动力学的临床分析

目的对比研究尿动力学检查在不同病程的神经源性膀胱患者的差异。方法对比21例神经源性膀胱患者中的尿动力涫检查结果,了解尿动力学检查结果与病程之间的相互关系。结果≥1 a组的排尿量、残余尿量、最大测压膀胱容量、最大尿流率、逼尿肌括约肌协同失调、功能性尿道长度、排尿前逼尿肌压力、膀胱顺应性和最大尿道闭合压均小于<1 a组,差异有统计学意义(P<0.05);而≥1 a组的逼尿肌漏尿点压、逼尿肌稳定性及收缩性大于<1 a组,差异无统计学意义(P>0.05)。结论神经源性膀胱的膀胱功能和膀胱顺应性跟病程呈反比例关系。     

卒中后神经源性膀胱诊治专家共识

<正>在我国,卒中是目前致残率最高的疾病~[1],二级预防工作的开展广泛,血压控制、抗血小板治疗及抗动脉粥样硬化等都颁布了指南或共识。卒中可以导致多种功能障碍,现已针对卒中后抑郁、吞咽困难、认知障碍、营养障碍及肢体康复等进行了规范和建议,而卒中导致的神经源性膀胱(neurogenic bladder,NB)同样极大地影响患者生活质量,并且提升死亡率和致残率。为规范卒中后神经源性膀胱(post-stroke     

Neuroprostheses to treat neurogenic bladder dysfunction: current status and future perspectives

Background Neural prostheses are a technology that uses electrical activation of the nervous system to restore function to individuals with neurological or sensory impairment.Introduction This article provides an introduction to neural prostheses and lists the most successful neural prostheses (in terms of implanted devices).Current treatment The article then focuses on neurogenic bladder dysfunction and describes two clinically available implantable neural prostheses for treatment of neurogenic bladder dysfunction. Special attention is given to the usage of these neural prostheses in children.Future treatment Finally, three new developments that may lead to a new generation of implantable neural prostheses for bladder control are described. They may improve the neural prostheses currently available and expand further the population of patients who can benefit from a neural prosthesis.     

The laparoscopic implantation of neuroprothesis to the sacral plexus for therapy of neurogenic bladder dysfunctions after failure of percutaneous sacral nerve stimulation

Objectives: To report about our first short series of laparoscopic implantation of neuroprothesis—LION procedure—to the sacral plexus for treatment of different neurogenic bladder dysfunctions in patients in whom percutaneous sacral nerve stimulation (SNS) failed. Material and Methods: A unilateral sacral LION procedure was performed in four patients with a refractary interstitial cystitis, in 13 patients with refractory bladder overactivity (multiple sclerosis N= 8, spina bifida N= 1, incomplete paraplegia N= 2, diabetic cystopathy N= 1), one patient with a neurogenic bladder incontinence by Parkinson syndrome, and in four patients for treatment for bladder atonia (Fowler's syndrome). In all patients, not only previous medical treatments but also SNS by transforaminal implantation had failed. Laparoscopic exposure of the sacral nerves roots S2 to S4/5 is performed by a transperitoneal approach and a quad electrode is placed perpendicular to the sacral nerve roots for postoperative global stimulation of these sacral nerve roots. Results: All procedures were performed successfully by laparoscopy without any complications. The mean operative time for such a procedure was 34 min. In two patients of the series postoperative neuromodulation failed. In all further 19 patients with an actual follow‐up varying between three months and three years, neuromodulation is still working successfully. Conclusions: Our results underscore that the sacral LION procedure to the sacral plexus is effective and safe for treatment divers neurogenic bladder dysfunctions even after failure of the classical percutaneous technique of implantation.     

电刺激骶神经前根引起膀胱逼尿肌的单独收

目的：探讨应用阳极阻滞技术电刺激兔骶神经前根引起膀胱逼尿肌 单独收缩的可行性。方法:成年兔6只,通过手术造成痉挛性膀胱动物模型,切断骶神经后根后电刺激骶神经前根,测量电刺激时的膀胱内压和尿道内压。结果：5只兔阳极阻滞技术取得成功,刺激量以50μs,0. 02mA开始,随着刺激量的增加尿道内压先升后降,当刺激脉宽达到300 μs,刺激振幅达到1 mA时,尿道内压降为零,达到完全阻滞,此时膀胱逼尿肌会出现单独收缩,在这个过程中双下肢抖动也明显减少。结论：通过阳极阻滞技术电刺激兔骶神经前根引起膀胱逼尿肌单独收缩完全可行,但其安全性需要进一步研究。     

骶骨骨折并发骶神经损伤的手术治疗

目的探讨骶骨骨折并发骶神经损伤的手术疗效。方法回顾性分析采用手术治疗的32例并发骶神经损伤的骶骨骨折患者的临床及手术资料。结果全组32例均获得随访,随访时间10～50个月,中位随访时间27个月,未见内固定松动或断裂、切口感染、骨折不愈合及双下肢明显不等长等手术并发症。20例未行骶神经减压术者中（A组）,16例神经损伤完全恢复,3例部分恢复,1例未恢复;12例行骶神经减压术者中,6例完全恢复,5例部分恢复,1例未恢复。根据Majeed评分标准,A组优8例,良8例,中3例,差1例;B组优4例,良5例,中2例,差1例。结论经皮重建钢板内固定术有利于骨折的复位和骶神经损伤的功能恢复,骶神经明显受压时需同时行骶神经减压术。     

Prolonged electrical stimulation causes no damage to sacral nerve roots in rabbits

Previous studies have shown that, anode block electrical stimulation of the sacral nerve root can produce physiological urination and reconstruct urinary bladder function in rabbits. However, whether long-term anode block electrical stimulation causes damage to the sacral nerve root remains unclear, and needs further investigation. In this study, a complete spinal cord injury model was established in New Zealand white rabbits through T9–10 segment transection. Rabbits were given continuous electrical stimulation for a short period and then chronic stimulation for a longer period. Results showed that compared with normal rabbits, the structure of nerve cells in the anterior sacral nerve roots was unchanged in spinal cord injury rabbits after electrical stimulation. There was no significant difference in the expression of apoptosis-related proteins such as Bax, Caspase-3, and Bcl-2. Experimental findings indicate that neurons in the rabbit sacral nerve roots tolerate electrical stimulation, even after long-term anode block electrical stimulation.     

Electrophysiological exploration of the sacral conus

Summary Evoked urethral and anal responses are produced by electrical stimulation of penis, bladder neck and anus. Latency and duration of the responses after bladder neck and anal stimulation are greatly dependent on stimulus parameters, suggesting a polysynaptic reflex; penile stimulation probably involves an oligosynaptic pathway. In pathological conditions the responses are delayed and their duration reduced.

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Zusammenfassung Die urethralen und analen elektromyographischen Antworten auf elektrische Stimulationen von Penis, Blasenausgang und Anus wurden studiert. Die latente Periode und die Dauer der Antworten sind stark abhängig von dem Parameter der Stimulationen, was charakteristisch ist für polysynaptische Reflexe; Penisstimulation jedoch ist wahrscheinlich ein oligosynaptischer Reflex. In pathologischen Fällen sind die Antworten verzögert und ihre Dauer verkürzt.

     

Rectal motility after sacral nerve stimulation for faecal incontinence

Abstract  Sacral nerve stimulation (SNS) is effective against faecal incontinence, but the mode of action is obscure. The aim of this study was to describe the effects of SNS on fasting and postprandial rectal motility. Sixteen patients, 14 women age 33–73 (mean 58), with faecal incontinence of various aetiologies were examined. Before and during SNS, rectal cross-sectional area (CSA) and ano-rectal pressures were determined with impedance planimetry and manometry for 1 h during fast and 1 h postprandially. Neither in the fasting state nor postprandially did SNS affect the number of single rectal contractions, total time with cyclic rectal contractions, the number of aborally and orally propagating contractions, the number of anal sampling reflexes or rectal wall tension during contractions. Postprandial changes in rectal tone were significantly reduced during SNS ( P  < 0.02). Before SNS, median rectal CSA was 2999 mm² (range: 1481–3822) during fast and 2697 mm² (range: 1227–3310) postprandially ( P  < 0.01). During SNS, median rectal CSA was 2990 mm² (1823–3678) during fast and 2547 mm² (1831–3468) postprandially ( P  = 0.22). SNS for faecal incontinence does not affect phasic rectal motility but it impairs postprandial changes in rectal tone.