Abstract:

Objective　To explore the clinical efficacy of third-generation electrophysiological technique based on pelvic floor anatomy in the treatment of pelvic floor muscle hypertonicity. Methods　A retrospective analysis was performed on 36 male patients admitted to the First Affiliated Hospital of Jinan University from October 2022 to May 2023, with an age of 21-82 (48.47±19.68) years old. All of them were diagnosed as pelvic floor muscle hypertonicity. The clinical manifestations were characterized by dysuria such as urine waiting, fine urine line, urine interruption, and even urinary retention, with frequent urination, nocturnal urination, some accompanied by difficulty in defecation. Digital rectal examination showed tension of the anal sphincter. Color ultrasound indicated a prostate size of 23-43 (32.42±5.24) g. Three of 36 patients had catheters retained due to urinary retention. Each patient took tamsulosin sustained-release capsules (0.2 mg qn) or silodosin capsules (4 mg bid) for 2-4 weeks, and the clinical symptoms did not improve. Twenty-six patients with difficulty in defecation were treated with percutaneous low-frequency pulse electrical stimulation. Before treatment, infrared thermal imaging detection was provided for each patient to visualize the selection of personalized electrotherapy parameters, to perform precise treatment. After every 10 treatments, infrared thermal imaging detection was repeated to adjust electrical stimulation treatment parameters. Paired t test and χ² test were used. Results　After electrostimulation treatment, the urinary waiting time [(2.39±1.44) s] was shorter than that before treatment [(41.21±12.25) s], the maximum urinary flow rate (Q_max) [(16.06±1.90) ml/s] was higher than that before treatment [(7.46±1.39) ml/s], the frequency of urination [(6.00±0.71) times] was lower than that before treatment [(10.76±1.50) times], and the frequency of nocturnal urination [(0.45±0.50) times per night] was lower than that before treatment [(2.06±1.22) times per night], with statistically significant differences (all P<0.000 1). After treatment, the catheter was pulled out in all the patients with urinary retention and the urination was smooth. The incidence of difficulty in defecation was 72.0% (26/36) before treatment and 0 after treatment. Conclusions　In adopting α1-receptor blockers are ineffective in treating dysuria and accompanied by a history of difficulty in defecation, pelvic floor muscle hypertonicity should be considered. The third-generation electrophysiological technology has achieved satisfactory short-term clinical efficacy in the treatment of pelvic floor muscle hypertonicity. With the increase of treatment cases, the long-term clinical efficacy of the technology will be further confirmed, providing a reliable new method for the treatment of pelvic floor muscle hypertonicity.

Key words:

Third-generation electrophysiological technology, Percutaneous low-frequency pulse electrical stimulation, Pelvic floor muscle hypertonicity

摘要：

目的　探讨基于盆底解剖三代电生理技术治疗盆底肌过度紧张的临床疗效。方法　回顾性分析2022年10月至2023年5月在暨南大学附属第一医院就诊的36例男性患者，年龄21～82（48.47±19.68）岁，均诊断为盆底肌过度紧张，临床表现以尿等待、尿线细、尿中断、尿潴留等排尿困难为特征，可出现尿频、夜尿，部分伴有排粪困难，直肠指检肛门括约肌紧张。彩超前列腺大小23～43（32.42±5.24）g。其中3例患者因尿潴留留置尿管。每例患者在电生理技术治疗前均口服盐酸坦索罗辛缓释胶囊（0.2 mg，每晚1次）或赛洛多辛胶囊（4 mg，每日2次）2～4周，临床症状没有改善。26例患者伴有排大便困难，采用经皮低频脉冲电刺激治疗。治疗前给予每例患者红外线热成像检测，可视化选择患者个体化电治疗参数，精准治疗，每完成10次治疗，重复红外线热成像检测，调整电治疗参数。采用配对t检验、χ²检验。结果　患者电刺激治疗后尿等待时间［（2.39±1.44）s］短于治疗前［（41.21±12.25）s］，最大尿流率（Q_max）［（16.06±1.90）ml/s］高于治疗前［（7.46±1.39）ml/s］，尿频次数［（6.00±0.71）次］低于治疗前［（10.76±1.50）次］，夜尿次数［（0.45±0.50）次/晚］少于治疗前［（2.06±1.22）次/晚］，差异均有统计学意义（均P<0.000 1）。尿潴留患者治疗后均顺利拔除尿管，排尿顺畅。排大便困难治疗前发生率为72.0%（26/36），治疗后发生率为0。结论　在采用α1受体阻滞剂治疗排尿困难后无效，伴有排大便困难时，要考虑盆底肌过度紧张。三代电生理技术治疗盆底肌过度紧张获得满意的近期临床疗效，随着治疗例数增加，远期疗效将得到进一步证实，为治疗盆底肌过度紧张提供了一种可靠的新方法。

关键词:

三代电生理技术, 经皮低频脉冲电刺激, 盆底肌过度紧张