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相关概念视频

The Micturition Reflex01:26

The Micturition Reflex

635
Urination, or micturition involves the coordination of the bladder's detrusor muscle and two sphincters to ensure controlled bladder emptying.
The process begins with bladder filling, where the bladder wall stretches as urine accumulates. This stretching activates the urine storage reflex, mediated by the sacral spinal segments and the pontine storage center. Efferent sympathetic impulses stimulate the detrusor muscle to relax and the internal urethral sphincter to contract, facilitating...
635

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神经神经调节用于神经性下尿路功能障碍.

Martina D Liechti1, Stéphanie van der Lely1, Stephanie C Knüpfer1,2

  • 1Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.

NEJM evidence
|February 6, 2024
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概括

在选定的患者中,神经神经调节 (SNM) 有效地治疗神经性下尿路功能障碍 (NLUTD). 这项研究表明,与基线相比,SNM显著改善了症状,即使刺激被关闭.

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科学领域:

  • 神经学 神经学
  • 泌尿器科 泌尿器科 泌尿器科 泌尿器科
  • 生物医学工程 生物医学工程

背景情况:

  • 神经性下泌尿道功能障碍 (NLUTD) 是一种常见且使人衰弱的疾病,常常不令人满意的标准治疗方法.
  • 圣神经调节 (SNM) 已为非NLUTD确立,但对NLUTD患者缺乏随机对照试验的强有力的证据.
  • 耐火性NLUTD是一个重大挑战,需要先进的治疗方案.

研究的目的:

  • 评估神经神经调节 (SNM) 在耐火性神经性下尿路功能障碍 (NLUTD) 患者的疗效.
  • 为了比较连续SNM与间歇性SNM在管理NLUTD中的成功率.
  • 评估在NLUTD患者中SNM影响的持久性.

主要方法:

  • 一个虚假控制,双盲,多中心试验,涉及耐火NLUTD患者.
  • 患者接受了SNM测试,成功的候选人接受了永久的神经刺激器植入和优化下感官刺激.
  • 参与者被随机分配到SNM ON或SNM OFF组2个月,以评估持续的影响.

主要成果:

  • 在124名被测试的患者中,65人 (52%) 显示下尿路功能有所改善,其中60人是随机的.
  • 在SNM ON组中,成功率为76%,而在SNM OFF组中,成功率为42%,表明持续效应 (OR=4.35,P=0.009).
  • 该研究报告了11个不良事件,在干预阶段没有退学.

结论:

  • 圣神经调节 (SNM) 在精心挑选的神经病患者中证明了在纠正耐受性神经性下尿路功能障碍 (NLUTD) 中的短期疗效.
  • SNM为NLUTD提供了一种可行的治疗选择,即使在停用后,也可能带来持续的益处.
  • 进一步的研究可能会探索NLUTD中SNM的长期结果和最佳刺激参数.