目的: To share the initial experience of sacral neuromodulation (SNM) in the treatment of patients with diabetic neurogenic bladder.
 

方法: From October 2016 to December 2017, 3 patients with diabetic neurogenic bladder were enrolled in our center. There were 2 females, 1 male, aged 44 to 68 years old, and a history of diabetes 5 years and 23 years. History of bladder dysfunction 2  6 years, the clinical manifestations of frequent urination, dysuria, chronic urinary retention (residual urine > 300ml), patients were diagnosed with neurogenic bladder by imaging urodynamics. All the 3 patients were treated with SNM. The phase I test was extended to 3 to 5 weeks. The number of urination, the number of nocturia, the secondary urine output, the degree of urgency and the difficulty of urinary dysfunction were evaluated by the urination diary, and the residual urine was reviewed. If the effect is not good, the electrode is removed, and the second-stage permanent stimulator (IPG) is implanted.
 

结果:  One patient in this group had a poor effect in the first-stage experience. The patient was a female with preoperative residual urine of 1400 ml, with hydronephrosis, and mild serum creatinine. Considering that SNM was ineffective, the electrode was removed under local anesthesia. Intermittent cleansing of self-guided catheterization. In the other two patients, the number of urination at 24 h was (16.3 ± 6.1) times and (8.8 ± 4.1) times, and the dysuria and waiting scores were compared in the test period compared with those before receiving SNM. (7.8±2.3) points and (4.3±1.2) points, respectively, the number of nocturia was (4.0±1.8) times and (2.5±1.7) times. The urgency scores were (3.1±1.7) points and (1.9±1.1) points, and the quality of life scores were (5.4±0.7) points and (4.0±, respectively). 1.0) points, the difference was statistically significant (P<0.05); the secondary urine output was (145.7±73.5) ml and (189.0±66.4) ml, respectively. The significance of learning (P = 0.18, P = 0.48), B-review of residual urine were <200ml, considering the effectiveness of SNM, after the completion of the test period, they were all implanted with stage II permanent stimulator. The conversion rate for this group of patients was 66.7% (2/3). Two patients with stage II permanent stimulator were followed up for 6 months and 9 months, respectively, and continued to be effective.
 

结论: SNM is an safe and effective minimally invasive treatment for patients with diabetic bladder-derived bladder with mild bladder damage. Appropriate patient selection, careful surgical procedures, and appropriate extension of test time can increase conversion rates and improve outcomes.