Helping patients with voiding dysfunction: What are our current options?
Notice bibliographique
Résumé
Patients with voiding dysfunction, such as overactive bladder (OAB) syndrome and non-obstructive retention, who have failed conservative treatment are candidates for sacral nerve stimulation (SNS). Sacral nerve stimulation was originally described by Tanagho and Schmidt.1 Medtronic received United States Food and Drug Administration (FDA) approval for Interstim in July 1998 for urge incontinence. To proceed with full implant, patients were initially tested with a percutaneous nerve evaluation (PNE). The percutaneous permanent tined lead (PPTL) was released in 2002 and is now the most commonly used procedure performed prior to a patient receiving a permanent implant.2 The advantage of the PPTL over PNE is higher implantation rates 88% versus 46%.3 Richard and colleagues used an interesting approach looking at the PNE as an adjunct to the PPTL and the implanted pulse generator implant. They performed a retrospective chart review of 106 patients who underwent 116 PNEs. Of these 116 patients, 62 (53%) had a successful PNE. Of these successful cases, 57 (92%) went on to an implant. Using the PNE allowed them to pre-select patients for PPTL, which increased their overall success.4 The authors address noteworthy considerations in their approach to SNS. The most worthwhile is the use of a 60% goal for symptom improvement compared to the standard 50%, which was an initial arbitrary goal. Some may argue we should consider an even higher improvement rate, possibly 70%. The authors astutely point out that the placebo success rate for anticholinergics can be as high as 60%, clearly explaining why some patients do not improve even after a full implant. Considering the significant expense of the product, elimination of the placebo effect would decrease cost, improve efficacy and prevent unnecessary procedures. Additionally, the authors discuss the prospect that using this three-stage approach may reduce the overall cost of SNS, as the cost of the PPTL staged approach is significantly less than a PNE. This may reduce the general cost to society; however, with the lower success rate of PNE, one cannot help but wonder if treatment is being withheld from some patients who are suffering. The authors should be commended for reviewing their data and trying to identify cost-efficient and more efficacious methods of providing care for their patients. A large multi-centre trial evaluating cost and efficacy would be optimal, but unfortunately improbable. As new treatment modalities enter the market, we must continue to assume the responsibility to weigh their costs and benefits to achieve the best outcomes for the greatest number of patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,020 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,003 | 0,003 |
| Communication savante | 0,006 | 0,013 |
| Science ouverte | 0,003 | 0,003 |
| Intégrité de la recherche | 0,008 | 0,014 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,010 | 0,004 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».