鉴于最近的证据表明尿道在引起压力和急迫性尿失禁中的作用,需要对有关女性尿道功能和功能障碍的文献进行严格的评估。
使用文献中的选定文章进行证据评估,这些文章包含影响尿道功能和失败因素的机制数据。
压力性尿失禁(SUI)的最大尿道闭合压力(MUCP)比正常对照组低40%。来自五名女性的证据显示,横纹肌/平滑肌对MUCP的贡献相对相等,血管丛,结缔组织。MUCP在相似年龄的个体中变化两倍,即使在未生育妇女中也每十年下降15%。年龄解释了MUCP中57%的变异。这与横纹/平滑肌损失和神经密度降低平行。影响每分钟和十年到十年压力变化的因素知之甚少。尚未研究结缔组织变化。在产后持续9个月的从头SUI中,MUCP比年龄和胎次匹配的对照组少25%。纵向研究未显示阴道分娩后尿道功能的显着变化,表明从出生起尿道支持的变化可能会掩盖先前存在的括约肌无力并沉淀SUI。支撑损伤之间的相互作用机制,预先存在的尿道无力,和神经病尚不清楚。
尿道衰竭是SUI的主要原因,也是UUI的一个促成因素;可能解释了为什么混合症状在流行病学研究中占主导地位。年龄相关的横纹肌损失和相似年龄的女性之间的差异是尿道闭合不良的突出特征。然而,结缔组织改变,血管功能,因素之间复杂的相互作用知之甚少。
A critical appraisal of the literature regarding female urethral function and dysfunction is needed in light of recent evidence showing the urethra\'s role in causing stress and urge urinary incontinence.
An evidence assessment was conducted using selected articles from the literature that contained mechanistic data on factors affecting urethral function and failure.
Maximal urethral closure pressure (MUCP) is 40% lower in stress urinary incontinence (SUI) than normal controls. Evidence from five women shows relatively equal contributions to MUCP from striated/smooth muscle, vascular-plexus, connective tissue. MUCP varies twofold in individuals of similar age and declines 15% per decade even in nulliparous women. Age explains 57% of the variance in MUCP. This parallels with striated/smooth muscle loss and reduced nerve density. Factors influencing pressure variation minute-to-minute and decade-to-decade are poorly understood. Connective tissue changes have not been investigated. MUCP in de novo SUI persisting 9-months postpartum is 25% less than in age and parity-matched controls. Longitudinal studies do not show significant changes in urethral function after vaginal birth suggesting that changes in urethral support from birth may unmask pre-existing sphincter weakness and precipitate SUI. Mechanisms of interaction between support injury, pre-existing urethral weakness, and neuropathy are unclear.
Urethral failure is the predominant cause of SUI and a contributing factor for UUI; potentially explaining why mixed symptoms predominate in epidemiological studies. Age-related striated muscle loss and differences between women of similar age are prominent features of poor urethral closure. Yet, connective tissue changes, vasculature function, and complex interactions among factors are poorly understood.