Objective To summarize the initial experiences of applying sacral neuromodulation (SNM) for refractory interstitial cystitis/pelvic pain syndrome (IC/PPS).Methods From January 2013 to August 2016,26 patients with refractory IC/PPS (including 5 males and 21 females) treated with SNM were recruited in Beijing Chaoyang Hospital and Hebei Yanda Hospital in this retrospective study.The data before operation,after implantation of stage Ⅰ tined lead,and during short-term follow-up after implantation of stage Ⅱ implanted pulse generator (IPG) were compared in order to observe the improvement of relevant symptoms,and to summarize the effectiveness and safety of SNM for IC/PPS.Results All the 26 patients received stage Ⅰ tined lead implantation under local anesthesia,of whom 7 patients finally had the tined lead removed under local anesthesia because of poor testing effects.And 19 patients chose embedding of IPG at the end of stage Ⅰ,with the conversion rate from stage Ⅰ to stage Ⅱ being 73.1％.The mean follow-up time after stage Ⅱ was 12.1 months.The data at the end of follow-up compared with those before treatment were:voiding frequency in 24 hours 24.3 ± 9.6 vs 13.5 ± 5.7,nocturia 4.6 ± 2.2 vs 2.7 ± 1.5,average voiding amount (109.4-± 45.3) vs (172.6 ± 61.6) ml,O'leary-sant scale score 26.0 ± 3.1 vs 17.0 ± 3.8,quality of life (QOL) score 5.7 ±0.4 vs 3.3 ± 1.3,sex rating 5.4 ± 1.4 vs 2.9 ± 1.6,and Numeric Pain Intensity Scale 8.4 ± 1.7 vs 3.9 ± 1.2 (all P ＜ 0.05).During the follow-up period for the 19 patients,11 showed symptoms relieve without recurrence,5 patients had slightly symptoms recurrence and 3 patients had severe recurrence of pelvic pain and frequent urination.About 42.1％ (8/19) patients received reprogramming,the average reprogramming rate being 1.73/person.And 84.2％ (16/19) patients had symptoms improvement greater than 50％ after stage Ⅱ IPG implantation.Conclusions SNM is an effective,safe and minimally invasive procedure for refractory IC/PPS.IC/PPS is a good indication for SNM with a high conversion rate from stage Ⅰ to stage Ⅱ.Patients should be followed up regularly after operation,and reprogramming should be arranged according to the degree of symptom improvement.%目的 总结骶神经调节(SNM)在治疗顽固性间质性膀胱炎/盆底疼痛综合征(IC/PPS)中的相关诊治经验.方法 回顾性分析2013年1月至2016年8月首都医科大学附属北京朝阳医院和河北燕达医院应用SNM疗法治疗的26例IC/PPS患者(其中男5例,女21例)资料,对比术前、Ⅰ期自固定电极植人后及Ⅱ期永久刺激器植人后短期随访中相关症状的改善程度,观察该疗法的有效性及安全性,并总结相关经验.结果 26例患者均在局麻下接受了骶神经调节Ⅰ期自固定电极体验治疗,7例患者测试效果不佳,于局麻下实施电极拔除.19例患者接受Ⅱ期永久刺激器植人,Ⅰ期至Ⅱ期转换率为73.1％,Ⅱ期永久刺激器植人术后平均随访时间12.1个月.接受Ⅱ期永久植人患者治疗前和截止随访时的相关数据分别为:24 h排尿次数(24.3±9.6)比(13.5±5.7)次,夜尿(4.6±2.2)比(2.7±1.5)次,尿量(109.4±45.3)比(172.6±61.6) ml,0'leary-sant评分(26.0±3.1)比(17.0±3.8)分,QOL评分(5.7±0.4)比(3.3±1.3)分,性生活评分(5.4±1.4)比(2.9±1.6)分,数字疼痛评分(8.4±1.7)比(3.9±1.2)分(均P＜0.05).19例患者随访过程中,11例症状持续缓解;5例出现轻微反复,3例出现较严重的盆底疼痛及尿频症状反复,42.1％ (8/19)的患者进行过参数调整,平均参数调整为1.73次/人,Ⅱ期永久刺激器植人术后症状改善＞50％的比例为84.2％ (16/19).结论 SNM是治疗IC/PPS安全、有效的微创治疗方式;IC/PPS的Ⅰ至Ⅱ期手术转换率较高,是SNM较好的手术适应证;患者在术后需要接受定期随访,根据症状改善情况及时进行参数调整.
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