盆底生物反馈电刺激治疗缺血性脑卒中尿失禁患者的临床观察

目的观察盆底生物反馈电刺激对缺血性脑卒中尿失禁患者的治疗效果。方法将80例缺血性脑卒中临床症状表现为尿失禁的患者,随机分为治疗组及对照组。治疗组予以标准护理干预联合盆底生物反馈电刺激治疗,对照组仅予以标准护理干预,并分别于治疗前、治疗4周后,行床旁B超测定膀胱残余尿量、并对泌尿症状困扰及国际下尿路症状进行评分。结果两组患者经治疗后症状均有好转,但与对照组相比,治疗组膀胱残余尿量减少、泌尿症状困扰评分及国际下尿路症状评分改善明显,且有统计学意义(P0.05)。结论盆底生物反馈电刺激能改善缺血性脑卒中患者尿失禁症状,并提高患者的生活质量。     

中枢神经损伤后膀胱功能障碍的治疗

中枢神经损伤疾病主要包括脊髓损伤(SCI)和脑卒中两大类,常可造成膀胱功能障碍,出现尿潴留或尿失禁,易引起尿路感染和肾积水,甚至出现尿毒症和肾功衰竭等,严重者危及生命。目前临床上治疗多采用间歇导尿、药物、膀胱训练和手术等治疗方法,但这些治疗多数存在不良反应和局限性。因此,选择盆底肌电生物反馈这类新兴的合理有效的治疗方案,对于患者的生存及生活质量都极为重要。本文将综述中枢神经损伤后膀胱功能障碍的传统治疗及盆底肌电生物反馈等新技术和进展。     

间歇导尿结合生物反馈电刺激治疗脑梗死后早期潴留的应用探讨

目的 观察脑梗死后尿潴留患者尿流动力学相关指标的变化,探讨间歇导尿结合生物反馈电刺激治 疗的有效性和作用机制。 方法 入选2014年1月-2016年1月急性脑梗死后尿潴留患者98例,对所有患者进行一般情况检查, 根据患者和（或）家属意愿分为治疗组48例和对照组50例,对照组采用无菌间歇导尿结合膀胱功能 训练治疗,治疗组在对照组基础上采用生物反馈电刺激治疗仪。分别于治疗前和治疗后1周测定两组 情况,包括生活质量精简问卷评分（Subjective Quality of Life Profile,SQLP）和尿流动力学指标。 结果 两组的尿潴留情况均逐渐好转,治疗组经治疗7次后,恢复自主排尿时间早于对照组（P ＜0.01）,治疗组的膀胱容量、残余尿量和最大尿流率改善优于对照组（P＜0.01）。 结论 间歇导尿结合生物反馈电刺激治疗改善脑梗死后早期尿潴留状况效果更好。     

前列腺增生电切术后并发尿潴留患者的心理舒适护理

目的 探讨前列腺增生术后并发尿潴留患者的心理舒适护理有效性.方法 对27例前列腺增生术后并发尿;留的患者采用心理舒适护理,并与单纯盆底肌训练治疗组对照分析.结果 心理舒适护理组(14例)总有效率92.8%高于.纯盆底肌训练组(13例).结论 对前列腺增生术后并发尿潴留患者及时进行心理舒适护理干预,可有效治愈尿潴留,提高...     

异搏定治疗脑卒中所致的尿失禁

我科从1990年4月用异搏定治疗脑卒中所致的尿失禁兀例，收到一定效果，现报道如下：1资料与方法1．1临床资料：26例患者中男22例，女4例，年龄最小50岁，最大80岁。其中脑血栓形成20例、脑出血6例，均经CT证实。病变部位在基底节者20例，额叶者4例、CT正常2例，12例合并脑萎缩。所有患者均有不同程度的偏瘫，部分病人伴有语言障碍及轻中度智力障碍。单纯尿失禁20例，合并大便失禁6例，入选病例均发病半月以上，尿失禁持续一周以上。有意识障碍及重度痴呆者不列为观察对象。26例中轻度尿失禁（尿急尿频，去厕所途中偶有失禁则例，中度尿失…     

等离子前列腺电切术后尿失禁神经损伤因素分析及治疗对策

目的：探讨等离子前列腺电切术后尿失禁原因及防治对策。方法选取2012‐01—2014‐01我院收治的140例前列腺增生患者，随机数字表法分为2组，即等离子前列腺电切术组（PKRP组，70例）和经尿道前列腺电切术组（TURP组， 70例），统计分析2组患者的尿失禁发生情况。结果 PKRP组患者的尿失禁发生率10％，明显低于TURP组的28.6％（P＜0.05）；随着时间的推移2组尿失禁均得到有效恢复，PKRP组尿失禁恢复时间明显较TURP组短（P＜0.05）。结论等离子前列腺电切术后尿失禁发生率较经尿道前列腺电切术低，临床应积极分析其发生因素并采取有针对性的措施，从而降低尿失禁发生率。     

脑电生物反馈治疗失眠症的疗效观察

目的：观察脑电生物反馈对失眠症的治疗效果。方法：将70例失眠症患者随机分为研究组和对照组各35例，研究组进行脑电生物反馈治疗，对照组进行药物治疗，治疗前后进行匹茨堡睡眠质量指数量表（PSQI）评定，比较两组疗效。结果：治疗后，研究组PSQI总分及睡眠潜伏期、睡眠持续性、习惯性、使用睡眠药物、睡眠紊乱、白天功能紊乱等因子分均较治疗前显著降低；与对照组比较，研究组治疗后睡眠潜伏期，睡眠持续性，白天功能紊乱等因子分降低更明显。结论：脑电生物反馈治疗可以明显改善失眠症患者症状，疗效优于传统药物治疗。     

同一机构9年间1 203例肾移植后尿瘘处理27例

目的：尿瘘作为肾移植后早期最常见的外科并发症发生率可高达3%~10%，处理不当容易致移植肾丢失。文章回顾性分析肾移植后并发尿瘘临床资料，结合文献总结其处理经验。 方法：选择解放军广州军区广州总医院2000-12/2009-03肾移植1 203例中发生尿瘘患者27例，接受尸体供肾26例，活体供肾1例，男16例，女11例，平均年龄43岁。所有患者确定为尿瘘后先采取留置18Fr双腔气囊导尿管治疗，如果效果不好可采用手术探查。17例采用保守治疗，其中12例单纯伤口引流+留置膀胱18Fr导尿管双向引流，5例经膀胱镜逆行置入输尿管支架+留置膀胱18Fr导尿管；10例进行开放手术探查，其中5例行移植肾输尿管与膀胱重新吻合术+置入输尿管支架，5例开放手术移植肾输尿管与自体输尿管端端吻合+置入输尿管支架，开放手术中有6例加用带蒂大网膜包绕于吻合口。 结果：移植后因再次尿瘘而行手术损伤肾静脉切除移植肾1例，26例尿瘘治愈,随访3个月~7年，无再发尿瘘、吻合口狭窄、移植肾无积水及尿路感染，肾功能正常。 结论：对于肾移植后尿瘘应早诊断、早治疗,可先采取保守治疗，大多数患者可以治愈，无效后及时采取手术干预，对于复杂性的尿瘘于吻合口处可采用带蒂大网膜包绕提高手术成功率。     

小儿多动症脑电生物反馈治疗依从性差的原因及干预对策

目的：探讨小儿多动症脑电生物反馈治疗依从性差的原因及干预对策。方法对72例小儿多动症脑电生物反馈治疗依从性差的患儿进行问卷调查，依据调查结果分析患儿依从性差的原因，同时采取相应的针对措施进行干预，观察干预效果。结果小儿多动症脑电生物反馈治疗依从性较差的原因主要包括以下几方面：26.4％的家长认为小儿多动症不需要治疗，患儿长大后会慢慢好转；23.6％家长认为脑电生物反馈治疗效果不理想；15.3％患儿由于学习等问题放弃了治疗等。通过实施针对性的干预对策后，59例小儿多动症患儿回院继续接受治疗，返院治疗率81.9％。结论小儿多动症脑电生物反馈治疗依从性差的原因较为复杂，应加强与小儿多动症患儿家长的交流与宣传教育，提高治疗过程中的医疗质量等。     

2型糖尿病并发脑梗死临床治疗分析

目的探讨2型糖尿病并发脑梗死患者的治疗方法及效果。方法选取我院2009-05-2011-02收治的40例2型糖尿病并发脑梗死患者设为治疗组,选取同期我院收治的40例单纯糖尿病患者设为对照组。2组入院后均行常规基础治疗,如控制血压、改善脑供血等,观察分析2组患者的神经功能缺损情况以及临床治疗效果。结果经过治疗后,治疗组患者有效16例,好转17例,无效7例,总有效率为82.5%;对照组患者有效21例,好转18例,无效1例,总有效率为97.5%,2组对比差异具有统计学意义（P〈0.05）;治疗组神经功能缺损轻度4例,中度17例,重度19例,对照组经功能缺损轻度21例,中度11例,重度8例,对照组也明显优于治疗组,P〈0.01,具有统计学意义。结论对糖尿病并发脑梗死患者,控制好血糖是重要的措施,是提高患者的生命质量及生活质量的重要手段。     

骶神经刺激治疗神经源性膀胱的疗效观察

目的 观察骶神经刺激(SNS)治疗神经源性膀胱的疗效.方法 使用SNS治疗94例神经源性膀胱患者,观察SNS治疗前和治疗1周后的尿失禁症状简易评分(ICI-Q-SF评分)、排尿日记(包括尿失禁次数、尿垫试验、排尿次数、夜尿次数、排尿量等)和尿动力学检查指标(包括膀胱容量、逼尿肌压、最大尿流率、平均尿流率、膀胱颈压、最大尿道压、功能性尿道长度和残余尿量等),并对所得数据进行统计学分析.结果 治疗前ICI-Q-SF评分为(17.2±1.8)分,治疗后为(8.3±1.6)分,差异有统计学意义(P<0.05).与治疗前比较,尿失禁次数、排尿次数和夜尿次数显著减少(P<0.05),尿垫显著减轻(P<0.05),排尿量显著增加(P<0.05);膀胱容量、最大尿流率和平均尿流率显著增加(P<0.05),残余尿量显著减少(P<0.05),而逼尿肌压、膀胱颈压、最大尿道压和功能性尿道长度等无显著性改变(P＞0.05).本组总有效率为75.5%,无一例并发症发生.结论 SNS治疗神经源性膀胱的效果确切,症状改善明显,并发症少且发生率低,是值得临床推广的治疗方法.     

A Novel Externally Applied Neuromuscular Stimulator for the Treatment of Stress Urinary Incontinence in Women—A Pilot Study

Objectives: Neuromuscular electrical stimulation (NMES) is commonly used to treat lower urinary tract dysfunctions. This study evaluated the efficacy of a novel externally applied stimulator in the treatment of stress urinary incontinence (SUI). Materials and Methods: Nine women were included in this study. Provocative tests included a cough and jumping jack test assessed via pad weight. Ultrasound (US) imaging assessed pelvic floor muscle (PFM) contraction. A bladder filling protocol allowed for delineation of the bladder from the pelvic floor and standardized volume. External electrodes were used during 30 min, at least four times per week treatment protocol at home for eight weeks. Participants were blinded to US and were not instructed regarding pelvic floor contractions. Results: At week 1, participants could perform PFM contractions verified with US. More importantly, an 87.43% decrease in leakage was noted. At week 8, participants reported a 97.71% decrease in leakage (p= 0.0001). Changes noted in Incontinence Impact Questionnaire and Modified Oxford scores were significant (p= 0.0001 and p= 0.0001). Conclusions: NMES is frequently used to promote muscle strength and coordination. Studies have shown NMES to be effective in decreasing symptoms associated with SUI; however, few, if any, have used it as a primary treatment modality. The novel device in this study was shown to be effective in improving muscle strength, reducing or ablating the symptoms associated with SUI, and in eliciting PFM contractions. The device is noninvasive and can be used as a home treatment.     

Biofeedback therapy in fecal incontinence and constipation

Abstract  We examine the collected evidence for efficacy of biofeedback therapy (BFT) in incontinence and constipation by means of meta-analysis of randomized controlled trials. PubMed search was performed to identify treatment trials that match quality criteria (adequate control groups, randomization). They were entered into meta-analyses using fixed effect models and computing odds ratio (OR) and 95% confidence interval (CI) of treatment effects. For constipation, eight BFT trials were identified. In four trials, electromyographic (EMG) BFT was compared to non-BFT treatments (laxatives, placebo, sham training and botox injection), while in the remaining four studies EMG BFT was compared to other BFT (balloon pressure, verbal feedback) modes. Meta-analyses revealed superiority of BFT to non-BFT (OR: 3.657; 95% CI: 2.127–6.290, P  < 0.001) but equal efficacy of EMG BFT to other BF applications (OR: 1.436; CI: 0.692–3.089; P  = 0.319). For fecal incontinence, a total of 11 trials were identified, of which six compared BFT to other treatment options (sensory training, pelvic floor exercise and electrical stimulation) and five compared one BFT option to other modalities of BFT. BFT was equal effective than non-BFT therapy (OR: 1.189, CI: 0.689–2.051, P  = 0.535). No difference was found when various modes BFT were compared (OR: 1.278, CI: 0.736–2.220, P  = 0.384). Included trials showed a substantial lack of quality and harmonization, e.g. variable endpoints and missing psychological assessment across studies. BFT for pelvic floor dyssynergia shows substantial specific therapeutic effect while BFT for incontinence is still lacking evidence for efficacy. However, in both conditions the mode of BFT seems to play a minor role.     

An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis

The majority of patients with multiple sclerosis (MS) develop troublesome lower urinary tract symptoms (LUTS). Anecdotal reports suggest that cannabis may alleviate LUTS, and cannabinoid receptors in the bladder and nervous system are potential pharmacological targets. In an open trial we evaluated the safety, tolerability, dose range, and efficacy of two whole-plant extracts of Cannabis sativa in patients with advanced MS and refractory LUTS. Patients took extracts containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD; 2.5 mg of each per spray) for eight weeks followed by THC-only (2.5 mg THC per spray) for a further eight weeks, and then into a long-term extension. Assessments included urinary frequency and volume charts, incontinence pad weights, cystometry and visual analogue scales for secondary troublesome symptoms. Twenty-one patients were recruited and data from 15 were evaluated. Urinary urgency, the number and volume of incontinence episodes, frequency and nocturia all decreased significantly following treatment (P <0.05, Wilcoxon's signed rank test). However, daily total voided, catheterized and urinary incontinence pad weights also decreased significantly on both extracts. Patient self-assessment of pain, spasticity and quality of sleep improved significantly (P <0.05, Wilcoxon's signed rank test) with pain improvement continuing up to median of 35 weeks. There were few troublesome side effects, suggesting that cannabis-based medicinal extracts are a safe and effective treatment for urinary and other problems in patients with advanced MS.     

Electrical stimulation for the treatment of bladder dysfunction: current status and future possibilities

Electrical stimulation of peripheral nerves can be used to cause muscle contraction, to activate reflexes, and to modulate some functions of the central nervous system (neuromodulation). If applied to the spinal cord or nerves controlling the lower urinary tract, electrical stimulation can produce bladder or sphincter contraction, produce micturition, and can be applied as a medical treatment in cases of incontinence and urinary retention. This article first reviews the history of electrical stimulation applied for treatment of bladder dysfunction and then focuses on the implantable Finetech-Brindley stimulator to produce bladder emptying, and on external and implantable neuromodulation systems for treatment of incontinence. We conclude by summarizing some recent research efforts including: (a) combined sacral posterior and anterior sacral root stimulator implant (SPARSI), (b) selective stimulation of nerve fibers for selective detrusor activation by sacral ventral root stimulation, (c) microstimulation of the spinal cord, and (d) a newly proposed closed-loop bladder neuroprosthesis to treat incontinence caused by bladder overactivity.     

Sacral Nerve Stimulation for Treatment of Intractable Pain Associated with Cauda Equina Syndrome

Sacral nerve stimulation (SNS) is an effective treatment for bladder and bowel dysfunction, and also has a role in the treatment of chronic pelvic pain. We report two cases of intractable pain associated with cauda equina syndrome (CES) that were treated successfully by SNS. The first patient suffered from intractable pelvic pain with urinary incontinence and fecal incontinence after surgery for a herniated lumbar disc. The second patient underwent surgery for treatment of a burst fracture and developed intractable pelvic area pain, right leg pain, excessive urinary frequency, urinary incontinence, voiding difficulty and constipation one year after surgery. A SNS trial was performed on both patients. Both patients'' pain was significantly improved and urinary symptoms were much relieved. Neuromodulation of the sacral nerves is an effective treatment for idiopathic urinary frequency, urgency, and urge incontinence. Sacral neuromodulation has also been used to control various forms of pelvic pain. Although the mechanism of action of neuromodulation remains unexplained, numerous clinical success reports suggest that it is a therapy with efficacy and durability. From the results of our research, we believe that SNS can be a safe and effective option for the treatment of intractable pelvic pain with incomplete CES.     

Sacral electrical neuromodulation as an alternative treatment option for lower urinary tract dysfunction

Temporary electrical stimulation using anal or vaginal electrodes and an external pulse generator has been a treatment modality for urinary urge incontinence for nearly three decades. In 1981 Tanagho and Schmidt introduced chronic electrical stimulation of the sacral spinal nerves using a permanently implanted sacral foramen electrode and a battery powered pulse generator for treatment of different kinds of lower urinary tract dysfunction, refractory to conservative treatment. At our department chronic unilateral electrical stimulation of the S3 sacral spinal nerve has been used for treatment of vesi-courethral dysfunction in 43 patients with a mean postoperative follow up of 43,6 months. Lasting symptomatic improvement by more than 50 % could be achieved in 13 of 18 patients with motor urge incontinence (72,2 %) and in 18 of the 21 patients with urinary retention (85,7 %). Implants offer a sustained therapeutic effect to treatment responders, which is not achieved by temporary neuromodulation. Chronic neuromodulation should be predominantly considered in patients with urinary retention. Furthermore in patients with motor urge incontinence, refusing temporary techniques or in those requiring too much effort to achieve a sustained clinical effect. Despite high initial costs chronic sacral neuromodulation is an economically reasonable treatment option in the long run, when comparing it to the more invasive remaining therapeutic alternatives.     

Sacral electrical neuromodulation as an alternative treatment option for lower urinary tract dysfunction

Temporary electrical stimulation using anal or vaginal electrodes and an external pulse generator has been a treatment modality for urinary urge incontinence for nearly three decades. In 1981 Tanagho and Schmidt introduced chronic electrical stimulation of the sacral spinal nerves using a permanently implanted sacral foramen electrode and a battery powered pulse generator for treatment of different kinds of lower urinary tract dysfunction, refractory to conservative treatment. At our department chronic unilateral electrical stimulation of the S3 sacral spinal nerve has been used for treatment of vesi-courethral dysfunction in 43 patients with a mean postoperative follow up of 43,6 months. Lasting symptomatic improvement by more than 50 % could be achieved in 13 of 18 patients with motor urge incontinence (72,2 %) and in 18 of the 21 patients with urinary retention (85,7 %). Implants offer a sustained therapeutic effect to treatment responders, which is not achieved by temporary neuromodulation. Chronic neuromodulation should be predominantly considered in patients with urinary retention. Furthermore in patients with motor urge incontinence, refusing temporary techniques or in those requiring too much effort to achieve a sustained clinical effect. Despite high initial costs chronic sacral neuromodulation is an economically reasonable treatment option in the long run, when comparing it to the more invasive remaining therapeutic alternatives.