Obesity and stress urinary incontinence in women: compromised continence mechanism or excess bladder pressure during cough?
Obesity and stress urinary incontinence in women: compromised continence mechanism or excess bladder pressure during cough?
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DOI：
10.1007/s00192-017-3279-6
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发表时间：
2017-09-01
影响因子：
1.8
通讯作者：
DeLancey, John O.
中科院分区：
文献类型：
--
作者：
Swenson, Carolyn W.;Kolenic, Giselle E.;DeLancey, John O.
介绍和假设我们比较了两个假设，为什么肥胖与压力性尿失禁（SUI）：（1）肥胖增加的需求，尿道系统（如较高的咳嗽压力）和（2）肥胖妥协尿道功能和尿道阴道support.Methods的二次分析进行了使用数据从病例对照研究的妇女SUI。测量尿道阴道支持（POP-Q点Aa，尿道轴），尿道功能（最大尿道闭合压，MUCP），并测量膀胱系统的需求（膀胱内压在休息和最大咳嗽）进行了分析。病例组和对照组被分为三个身体质量指数（BMI）组：正常（18.5-24.9 kg/m2）;超重（25.0-29.9 kg/m2）;和肥胖（>= 30 kg/m2）。创建逻辑回归模型以调查每个BMI组与SUI相关的变量。采用结构方程模型分析BMI、SUI、最大咳嗽压、MUCP和POP-Q点Aa之间的直接和间接关系。在所有BMI组中，MUCP是与SUI最密切相关的因素。肥胖女性的最大咳嗽压与SUI显著相关（OR 3.191，95% CI 1.326，7.683; p < 0.01），但在正常体重或超重女性中不相关。通径模型分析显示BMI与SUI通过最大咳嗽压有显著相关性（间接效应，p = 0.038），但不通过MUCP（间接效应，p = 0.243）或POP-Q点Aa（间接效应，p = 0.410）。结论我们的结果支持第一个假设，即肥胖与SUI相关，因为膀胱内压增加，这因此增加了对MEMS机构的需求。
Introduction and hypothesis We compared two hypotheses as to why obesity is associated with stress urinary incontinence (SUI): (1) obesity increases demand on the continence system (e.g. higher cough pressure) and (2) obesity compromises urethral function and urethrovaginal support.Methods A secondary analysis was performed using data from a case-control study of SUI in women. Measurements of urethrovaginal support (POP-Q point Aa, urethral axis), urethral function (maximal urethral closure pressure, MUCP), and measures of continence system demand (intravesical pressures at rest and during maximal cough) were analyzed. Cases and controls were divided into three body mass index (BMI) groups: normal (18.5-24.9 kg/m(2)); overweight (25.0-29.9 kg/m(2)); and obese (>= 30 kg/m(2)). Logistic regression models where created to investigate variables related to SUI for each BMI group. Structural equation modeling was used to test the direct and indirect relationships among BMI, SUI, maximal cough pressure, MUCP, and POP-Q point Aa.Results The study included 108 continent controls and 103 women with SUI. MUCP was the factor most strongly associated with SUI in all BMI groups. Maximal cough pressure was significantly associated with SUI in obese women (OR 3.191, 95% CI 1.326, 7.683; p < 0.01), but not in normal weight or overweight women. Path model analysis showed a significant relationship between BMI and SUI through maximal cough pressure (indirect effect, p = 0.038), but not through MUCP (indirect effect, p = 0.243) or POP-Q point Aa (indirect effect, p = 0.410).Conclusions Our results support the first hypothesis that obesity is associated with SUI because of increased intravesical pressure, which therefore increases demand on the continence mechanism.