RESUMO
OBJECTIVE: To determine predictors of success for sacral neuromodulation in women with overactive bladder, urinary retention, and fecal incontinence. METHODS: A retrospective chart review was performed on women who underwent a staged sacral neuromodulation implantation between 2007 and 2018. Clinical and procedural characteristics were recorded. Presence of intraoperative motor responses in either all 4 or <4 electrodes were used to group women. Endpoints included completion of stage II implant, tined lead revision, and patient-reported success. RESULTS: In 198 women with a mean age of 62.9 years (SD+/- 14.7), completion of stage II implant occurred in 92.4% of women, and 83.3% of these women reported success at the first postoperative visit. Continued success at 6 months was reported in 70.3%. Lead revision was noted in 23.0%. Age >65 years (odds ratio [OR]â¯=â¯0.2, 95% confidence interval [CI]â¯=â¯0.06-0.8) and prior onabotulinumtoxinA (onaBoNT-A) (ORâ¯=â¯0.2, 95% CIâ¯=â¯0.06-0.9) were negative predictors for completion of stage II implant on multivariable analysis. Also, prior pelvic floor physical therapy was a significant negative predictor of postoperative patient-reported success on multivariable analysis (ORâ¯=â¯0.25, 95% CIâ¯=â¯0.1-0.6). There were no differences seen in women who had motor responses with either all 4 electrodes or <4 electrodes in any endpoint (P > .05). CONCLUSION: Patient age >65 and history of prior onaBoNT-A were associated with failure to complete stage II implant. Women with prior pelvic floor physical therapy were less likely to report success after sacral neuromodulation. Motor responses in <4 electrodes during lead testing did not impact patient-reported success.
Assuntos
Incontinência Fecal , Diafragma da Pelve/fisiopatologia , Estimulação Elétrica Nervosa Transcutânea , Bexiga Urinária Hiperativa , Fatores Etários , Idoso , Eletrodos Implantados , Incontinência Fecal/fisiopatologia , Incontinência Fecal/terapia , Feminino , Humanos , Plexo Lombossacral/fisiologia , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Valor Preditivo dos Testes , Sacro , Estimulação Elétrica Nervosa Transcutânea/efeitos adversos , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Estimulação Elétrica Nervosa Transcutânea/métodos , Resultado do Tratamento , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária Hiperativa/terapia , Retenção Urinária/fisiopatologia , Retenção Urinária/terapia , Saúde da MulherRESUMO
The bioactive lipid sphingosine-1-phosphate (S1P) is involved in multiple cellular signalling systems and has a pivotal role in the control of immune cell trafficking. As such, S1P has been implicated in disorders such as cancer and inflammatory diseases. This Review discusses the ways in which S1P might be therapeutically targeted - for example, via the development of chemical inhibitors that target the generation, transport and degradation of S1P and via the development of specific S1P receptor agonists. We also highlight recent conflicting results observed in preclinical studies targeting S1P and discuss ongoing clinical trials in this field.