Video-urodynamics preliminary efficacy analysis of CT combined with C-arm guided sacral neuromodulation in the treatment of neurogenic bladder
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摘要: 目的:应用影像尿动力学(video-urodynamics)探讨CT联合C型臂引导骶神经调控术(SNM)治疗神经源性膀胱(NB)的疗效和安全性。方法:前瞻性分析我院2019年7月—2020年11月接受CT联合C型臂引导SNM治疗的23例NB患者的临床资料,术前基线期和术后体验期所有患者均行影像尿动力学评估并记录排尿日记,统计治疗总有效率、Ⅱ期转化率和并发症发生率。结果:体验期平均(29.5±9.1) d,与基线期相比,患者体验期排尿日记中日间排尿次数(9.9 vs.6.8)和日间导尿量(252.4 mL vs.152.3 mL)显著下降;日间排尿量(145.1 mL vs.207.4 mL)和功能性膀胱容量(218.8 mL vs.290.7 mL)显著增加;影像尿动力学中最大尿流率(7.9 mL/s vs.11.8 mL/s)、膀胱顺应性(17.9 mL/cmH2O vs.30.1 mL/cmH2O)和最大膀胱压测定容量(239.2 mL vs. 325.9 mL)显著增加;排尿前最大逼尿肌压力(20.3 cmH2O vs. 12.0 cmH2O)、生活质量评分(7.8 vs. 2.9)、膀胱过度活动症评分(5.0 vs. 1.5)和肠道功能障碍评分(12.5 vs. 4.7)均显著改善。基线期有5个输尿管单位存在膀胱输尿管反流,体验期2个输尿管单位反流消失,其余3个有不同程度的改善;基线期10例患者存在逼尿肌膀胱颈口协同失调,体验期7例(70%)消失;基线期12例患者逼尿肌外括约肌协同失调,体验期5例(42%)消失;整体有效率为95.7%(22/23),Ⅱ期转化率为82.6%(19/23),并发症发生率为4.3%(1/23),表现为伤口感染。结论:CT联合C型臂引导SNM是治疗NB的有效方法,短期即可改善其影像尿动力学膀胱尿道参数,表现为膀胱顺应性、膀胱输尿管反流程度和逼尿肌括约肌协同失调改善,并提高其生活质量。Abstract: Objective: To assess the video-urodynamics effectiveness and safety of CT combined with C-arm guided sacral neuromodulation(SNM) therapy for neurogenic bladder(NB).Methods: This study was prospectively designed and a total of 23 patients with NB who underwent poor conservative treatment or surgical treatment prior to CT combined with C-arm guided SNM treatment were enrolled from July 2019 to November 2020. All patients underwent video-urodynamics before and after stage Ⅰ implantation. Urodynamic examination and voiding diary data of patients before implantation and in stage Ⅰ after implantation were collected, then the difference was compared and statistical analysis was performed. Finally, the total effective rate of treatment, the conversion rate of stage Ⅰ to stage Ⅱ and the incidence of complications were calculated.Results: The average testing phase was(29.5±9.1) days. Compared with the baseline phase, voiding frequency(9.9 vs. 6.8) and daily catheterization volume(252.4 mL vs. 152.3 mL) decreased significantly, and average voiding amount(145.1 mL vs. 207.4 mL) and functional bladder capacity(218.8 mL vs. 290.7 mL) increased significantly in the voiding diary of the patients during the testing phase. The maximum urine flow rate(7.9 mL/s vs. 11.8 mL/s), bladder compliance(17.9 mL/cmH2O vs. 30.1 mL/cmH2O), and maximum cystometric capacity(239.2 mL vs. 325.9 mL) in the video-urodynamics increased significantly. Besides, the maximum detrusor pressure before urination(20.3 cmH2O vs. 12.0 cmH2O), quality of life score(7.8 vs. 2.9), OABSS score(5.0 vs. 1.5) and bowel dysfunction score(12.5 vs. 4.7) improved significantly. Five ureteral units had vesicoureteral reflux in baseline, 2 ureteral units disappeared and the other 3 had different degrees of improvement in testing phase. In the baseline phase, 10 patients had detrusor-bladder neck dyssynergia, 7 cases(70%) disappeared in the testing phase, 12 patients had detrusor-external sphincter dyssynergia in the baseline phase, and 5 cases(42%) disappeared in the testing phase. In the end, the effective rate of CT combined with C-arm guided SNM to treat neurogenic bladder was 95.7%(22/23), the conversion rate of stage Ⅰ to stage Ⅱ was 82.6%(19/23) and the complication(wound infection) rate was 4.3%(1/23).Conclusion: CT combined with C-arm guided SNM is an effective method for the treatment of NB. It can improve patients' video-urodynamic parameters significantly in the short term, which is manifested by improved bladder compliance, vesicoureteral reflux and detrusor sphincter dyssynergia, and then improved their quality of life.
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