Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinical outcomes of sacral neuromodulation in non-neurogenic, non-obstructive dysuria: A 5-year retrospective, multicentre study in China
Ling-Feng Meng, Wei Zhang, Jian-Ye Wang, Yao-Guang Zhang, Peng Zhang, Li-Min Liao, Jian-Wei Lv, Qing Ling, Zhong-Qing Wei, Tie Zhong, Zhi-Hui Xu, Wei Wen, Jia-Yi Li, De-Yi Luo
Ling-Feng Meng, Wei Zhang, Jian-Ye Wang, Yao-Guang Zhang, Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
Peng Zhang, Department of Urology, Beijing Chaoyang Hospital, Institute of Urology, Capital Medical University, Beijing 100000, China
Li-Min Liao, Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing 100000, China
Jian-Wei Lv, Department of Urology, South Campus, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200000, China
Qing Ling, Department of Urology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
Zhong-Qing Wei, Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
Tie Zhong, Department of Urology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710000, Shaanxi Province, China
Zhi-Hui Xu, Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou 310000, Zhejiang Province, China
Wei Wen, Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200000, China
Jia-Yi Li, Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200000, China
De-Yi Luo, Department of Urology, West China Hospital, Sichuan University, Chengdu 610000, Sichuan Province, China
Author contributions: Meng LF developed the protocol, analyzed the data, and wrote and edited the manuscript; Zhang W analyzed the data and wrote and edited the manuscript; Wang JY and Zhang YG developed the protocol and collected the data; Zhang P, Liao LM, Lv JW, Ling Q, Wei ZQ, Zhong T, Xu ZH, Wen W, Li JY, and Luo DY collected the data. All authors reviewed the manuscript.
Supported by National Key Research and Development Program of China, No. 2018YFC2002202.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Beijing Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yao-Guang Zhang, MD, Doctor, Department of Urology, Beijing Hospital, National Center of Gerontology, No. 1, Dahua Road, Dongdan, Dongcheng District, Beijing 100730, China. zhang003887@sina.com
Received: February 5, 2020
Peer-review started: February 5, 2020
First decision: April 21, 2020
Revised: May 8, 2020
Accepted: May 23, 2020
Article in press: May 23, 2020
Published online: June 26, 2020
BACKGROUND
Management of non-neurogenic, non-obstructive dysuria represents one of the most challenging dilemmas in urological practice. The main clinical symptom is the increase in residual urine. Voiding dysfunction is the main cause of dysuria or urinary retention, mainly due to the decrease in bladder contraction (the decrease in contraction amplitude or duration) or the increase in outflow tract resistance. Sacral neuromodulation (SNM) has been used for > 10 years to treat many kinds of lower urinary tract dysfunction. It has become increasingly popular in China in recent years. Consequently, studies focusing on non-neurogenic, non-obstructive dysuria patients treated by SNM are highly desirable.
AIM
To assess the outcome of two-stage SNM in non-neurogenic, non-obstructive dysuria.
METHODS
Clinical data of 54 patients (26 men, 28 women) with non-neurogenic, non-obstructive dysuria treated by SNM from January 2012 to December 2016 in ten medical centers in China were retrospectively analyzed. All patients received two or more conservative treatments. The voiding diary, urgency score, and quality of life score before operation, after implantation of tined lead in stage I (test period), and during short-term follow-up (latest follow-up) after implantation of the implanted pulse generator in stage II were compared to observe symptom improvements.
RESULTS
Among the 54 study patients, eight refused to implant an implanted pulse generator because of the unsatisfactory effect, and 46 chose to embed the implanted pulse generator at the end of stage I. The conversion rate of stage I to stage II was 85.2%. The average follow-up time was 18.6 mo. There were significant differences between baseline (before stage I) and the test period (after stage I) in residual urine, voiding frequency, average voiding amount, maximum voiding amount, nocturia, urgency score, and quality of life score. The residual urine and urgency score between the test period and the latest follow-up time (after stage II) were also significantly different. No significant differences were observed for other parameters. No wound infection, electrode breakage, or other irreversible adverse events occurred.
CONCLUSION
SNM is effective for patients with non-neurogenic, non-obstructive dysuria showing a poor response to traditional treatment. The duration of continuous stimulation may be positively correlated with the improvement of residual urine.
Core tip: This is the first multicenter retrospective study of sacral neuromodulation (SNM) in China, which can reflect the clinical effects of SNM in the treatment of non-neurogenic, non-obstruction dysuria patients in the past 5 years. Through the study, we can conclude that SNM is effective and safe for patients with non-neurogenic, non-obstructive dysuria showing a poor response to traditional treatment. The duration of continuous stimulation may be positively correlated with the improvement of residual urine.
