Why do women have stress urinary incontinence?
Why do women have stress urinary incontinence?
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DOI：
10.1002/nau.20888
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发表时间：
2010
影响因子：
2
通讯作者：
DeLancey, John O. L.
中科院分区：
文献类型：
--
作者：
DeLancey, John O. L.
关键词：
本文综述了有关压力性尿失禁病因的研究进展。在过去的一个世纪里，人们提出了几种假说来解释压力性尿失禁。这些理论建立在临床观察的基础上，主要集中在尿路支撑丧失和膀胱颈开放的致病作用上。最近，通过将患有原发性压力性尿失禁的女性与年龄、种族和产次相似的无症状志愿者的尿路支撑度和功能进行比较，验证了这些假设。最大尿路闭合压是两组间差异最大的参数，在有压力性尿失禁的女性中，这一参数比类似的无症状女性低43%，其效应值为1.6。测量尿路支撑效应大小的范围从0.5到0.6。由于任何一种客观的支持措施可能不能全面反映尿路膀胱活动的全貌，专家小组对咳嗽期间的盲法超声检查进行了回顾。该小组能够在57%的时间内正确识别患有压力性尿失禁的女性；仅比仅凭偶然预期的50%高出7%，证实了尿路膀胱流动性与压力性尿失禁没有很强的相关性。尽管对尿路提供不同支持的手术是有效的，但尿路支持并不是压力性尿失禁的主要原因。提高我们对影响尿道闭合的因素的了解，可能会导致针对尿路的新的治疗方法，并改善对当前手术微小但持久的失败率的理解。
This article reviews progress made in understanding the causes of stress urinary incontinence. Over the last century, several hypotheses have been proposed to explain stress urinary incontinence. These theories are based on clinical observations and focus primarily on the causative role of urethral support loss and an open vesical neck. Recently these hypotheses have been tested by comparing measurements of urethral support and function in women with primary stress urinary incontinence to asymptomatic volunteers who were recruited to be similar in age, race and parity. Maximal urethral closure pressure is the parameter that differs the most between groups being 43% lower in women with stress incontinence than similar asymptomatic women having as effect size of 1.6. Measures of urethral support effect sizes range from 0.5 to 0.6. Because any one objective measure of support may not capture the full picture of urethrovesical mobility, review of blinded ultrasounds of movements during cough were reviewed by an expert panel. The panel was able to identify women with stress incontinence correctly 57% of the time; just 7% above the 50% that would be expected by chance alone, confirming that urethrovesical mobility is not strongly associated with stress incontinence. Although operations that provide differential support to the urethra are effective, urethral support is not the predominant cause of stress incontinence. Improving our understanding of factors affecting urethral closure may lead to novel treatments targeting the urethra and improved understanding of the small but persistent failure rate of current surgery.
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DOI：
10.1196/annals.1389.034
发表时间：
2007-01-01
期刊：
REPRODUCTIVE BIOMECHANICS
影响因子：
--
作者：
Ashton-Miller, James A.;Delancey, John O. L.
通讯作者：
Delancey, John O. L.
DOI：
10.1111/j.1600-0412.1990.tb08027.x
发表时间：
1990-01-01
影响因子：
4.3
作者：
Petros, Peter E. Papa;Ulmsten, Ulf I.
通讯作者：
Ulmsten, Ulf I.
影响因子：
9.8
作者：
Clobes, Amy;DeLancey, John O. L.;Morgan, Daniel M.
通讯作者：
Morgan, Daniel M.
影响因子：
4.3
作者：
RUD, T
通讯作者：
RUD, T
DOI：
10.1016/s0002-9378(16)38792-0
发表时间：
1952-01-01
影响因子：
9.8
作者：
JEFFCOATE, TNA;ROBERTS, H
通讯作者：
ROBERTS, H