Abstract:

Objective　To explore the practicability, safety, and efficacy of appropriate electrophysiological techniques in the treatment of refractory overactive bladder (OAB) by percutaneous low-frequency neuromuscular electrical stimulation. Methods　From September 2019 to July 2022, 36 patients with refractory OAB were enrolled in the department of urology and lower urinary tract and male outpatient clinic of the First Affiliated Hospital of Jinan University. There were 28 females and 8 males, aged from 29 to 83 (43.94±2.68) years, with a disease duration of (4.19±2.43) years. Among the female patients, there were 8 cases of pelvic organ prolapse, 1 case with history of pelvic surgery combined with pelvic organ prolapse, 1 case with sleep disorders combined with history of pelvic surgery, 1 case with major depressive disorder, 2 cases with hypertension, 1 case with diabetes, 1 case with hypertension combined with diabetes, 3 cases with urge incontinence, and 10 cases with simple refractory OAB. Among the male patients, there were 2 cases with chronic prostatitis, 1 case with urgent incontinence, and 5 cases with simple refractory OAB. All patients received percutaneous low-frequency neuromuscular electrical stimulation. The scores of quality of life (QOL) scale, scores of Overactive Bladder Symptom Scale (OABSS), and urination diary were collected before and after treatment. The above indicators were statistically analyzed and the efficacy was evaluated. Follow-up data of 1 month and 3 months after treatment were analyzed to analyze the persistence of short-term clinical effect and recurrence rate in patients with OAB treated by percutaneous low-frequency neuromuscular electrical stimulation. Paired t test and Cox regression analysis were used. Results　After treatment, the QOL score of the refractory OAB patients was higher than that before treatment, and the OABSS score was lower than that before treatment, with statistically significant differences (t=1.327 and 102.244, both P<0.05); the frequency of urination was decreased after treatment compared with that before treatment, with a statistically significant difference (t=10.246, P<0.05); the single urine volume and single maximum urine volume were higher than those before treatment, with statistically significant differences (t=45.467 and 103.344, both P<0.05). The clinical symptoms of 29 patients with refractory OAB were improved after treatment, and the clinical effective rate reached 80.55% (29/36). In the 1-month and 3-month follow-up OABSS score data, the regression coefficients showed level significance results (P=0.033 and 0.002), indicating the short-term clinical efficacy of percutaneous low-frequency neuromuscular electrical stimulation for refractory OAB patients. The results of Cox regression analysis showed that the lower the OABSS score after 1 month and 3 months of treatment, the longer the validity period, the less likely to relapse. All patients had no discomfort during or after treatment. Conclusions　Percutaneous low-frequency neuromuscular electrical stimulation in the treatment of refractory OAB can significantly improve the patients' quality of life, reduce the score of OABSS, reduce the frequency of urination, increase the single urine volume and the single maximum urine volume. The treatment is safe and has significant short-term clinical efficacy. However, the long-term efficacy should be followed up with the increase of the number of cases.

Key words:

Refractory overactive bladder, Percutaneous low-frequency neuromuscular electrical stimulation, Overactive Bladder Symptom Scale,  , Urination diary

摘要：

目的　通过经皮低频神经肌肉电刺激治疗难治性膀胱过度活动症（OAB），探讨电生理适宜技术临床应用的实用性、安全性及有效性。方法　选取2019年9月至2022年7月暨南大学附属第一医院泌尿外科、下尿路疾病以及男科门诊诊治的难治性OAB患者36例。其中28例女性，8例男性，年龄29～83（43.94±2.68）岁，病程（4.19±2.43）年。女性患者中，盆腔脏器脱垂8例，盆腔手术史合并盆腔脏器脱垂1例，睡眠障碍合并盆腔手术史1例，重度抑郁症1例，高血压2例，糖尿病1例，高血压合并糖尿病1例，急迫性尿失禁3例，单纯性难治性OAB患者10例。男性患者中，慢性前列腺炎2例，急迫性尿失禁1例，单纯性难治性OAB患者5例。所有患者均接受经皮低频神经肌肉电刺激治疗。收集治疗前后生活质量量表评分、膀胱过度活动症症状评分表（Overactive Bladder Symptom Scale，OABSS）评分、排尿日记，对治疗前后的上述指标行统计学分析和疗效评价，分析治疗后1个月、3个月随访数据，分析经皮低频神经肌肉电刺激治疗OAB患者近期临床疗效的持久性、复发率。采用配对t检验、Cox回归分析。结果　治疗后，难治性OAB患者生活质量量表评分较治疗前升高，OABSS评分比治疗前降低，差异均有统计学意义（t=1.327、102.244，均P<0.05）；排尿次数治疗后较治疗前减少，差异有统计学意义（t=10.246，P<0.05）；单次尿量、单次最大尿量均高于治疗前，差异均有统计学意义（t=45.467、103.344，均P<0.05）。29例难治性OAB患者治疗后临床症状改善，临床有效率达到80.55%（29/36）。在1个月与3个月的随访OABSS评分数据中，回归系数呈现水平显著性结果（P=0.033、0.002），表明经皮低频神经肌肉电刺激治疗对难治性OAB患者的近期临床疗效；Cox回归分析结果表明治疗1个月、3个月后OABSS评分越低，其有效期越持久，越不容易复发。所有患者在治疗过程中和治疗后均无不适感觉。结论　经皮低频神经肌肉电刺激治疗难治性OAB，可明显提高患者生活质量，降低OABSS评分，减少患者排尿次数、增加单次尿量和单次最大尿量。该治疗安全，有显著的近期临床疗效，远期疗效需随着病例数的增加，长期随访观察。

关键词:

难治性膀胱过度活动症, 经皮低频神经肌肉电刺激, 膀胱过度活动症症状评分表, 排尿日记