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- 저자 : David Castro-Díaz (검색결과 2 건)
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Long-term Outcomes of Sacral Nerve Stimulation in Pelvic Floor Dysfunctions
David Hernández-Hernández,Bárbara Padilla-Fernández,Milagros Castro Romera,Stephany Hess Medler,David Castro-Díaz 대한배뇨장애요실금학회 2021 International Neurourology Journal Vol.25 No.4
Purpose: The aim of this study was to analyze the long-term outcomes of sacral nerve stimulation (SNS) in both idiopathic and neurogenic pelvic floor disorders in patients treated at a referral center. Methods: This retrospective observational study analyzed the records of 106 patients tested at our department from December 1999 to January 2017. The efficacy variables evaluated were the Global Response Assessment (range, 0%–100%) and, according to the clinical indication, other specific variables such International Consultation on Incontinence Questionnaire- Short Form, number of catheterizations or pads/day, and the numerical pain scale. The safety variables analyzed were complications (pain, migration, infection), reinterventions and explants. Patients’ quality of life (QoL) and satisfaction with the procedure were evaluated through telephone interviews. Results: The clinical indications were overactive bladder (OAB) (n=36), urinary retention (UR) (n=37), bladder pain syndrome/ interstitial cystitis (BPS/IC) (n=19), fecal incontinence (FI) (n=8), and double incontinence (DI) (n=6). The implant rates according to the clinical indication were as follows: OAB, 55.6%; UR, 56.8%; BPS/IC, 63.15%; FI, 87.5%; and DI, 66.7%. Clinical and/or statistically significant improvements in all efficacy variables were observed. Loss of therapeutic effect at 75 months of follow-up was observed in 34% of patients. Device-related pain appeared in 25 patients (39%); in 20 patients, it was resolved by reprogramming and 5 patients required device removal. An overall improvement in QoL and high levels of satisfaction with the procedure were observed. More than 90% of patients would recommend SNS to a friend or relative. Conclusions: SNS is a minimally invasive procedure that offers a real alternative to patients with refractory pelvic floor dysfunction. Its safety profile is very favorable and it provides a long-lasting improvement in symptoms and QoL.
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Jonathan Rodríguez Talavera,Begoña Ballesta Martínez,Melania Santacruz Perez,Manuel Felipe Ravina Pisaca,David Castro Díaz 대한배뇨장애요실금학회 2022 International Neurourology Journal Vol.26 No.S1
Purpose: We tested the hypothesis that the urethral pressure profile, in combination with electromyography of the urethral sphincter, may be useful as a predictor of urinary incontinence after radical prostatectomy (RP). The aim of this study was to assess whether the combination of these tests resulted in an improved tool for the prediction of post-RP urinary incontinence. Methods: Patients with indications for RP were included. The urethral pressure profile, including prostatic and sphincter components for maximum urethral closure pressure (MUCP) and functional urethral length, was recorded in combination with needle electromyography of the urethral sphincter. The mean and maximum amplitude of waves were measured twice: 1 month before RP and 6 months after the procedure. The 1-hour pad test was conducted in parallel with other tests. Patients completed the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). The relationship of the results of the tests with post-RP urinary incontinence was studied. Age, urodynamic parameters, pathologic stage, and surgical technique were recorded for analysis as potential confounding factors. Results: Nineteen patients were included within the 1-year study period. Their mean age was 63 years. According to the 1-hour pad test and ICIQ-SF, 42.1% of the sample had urinary incontinence after RP. Prostate MUCP with the mean and during-stress amplitude of waves predicted post-RP urinary incontinence with a sensitivity of 87.5% (P=0.002) in our model. Age, urodynamic parameters, pathological stage, and surgical technique were not related to incontinence after surgery. Conclusions: The combination of the urethral pressure profile (prostatic MUCP) and electromyography of the urethral sphincter might be a useful prognostic predictor of post-RP urinary incontinence.
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