Stress urinary incontinence
Stress urinary incontinence
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DOI：
10.1097/01.aog.0000137874.84862.94
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发表时间：
2004-09-01
影响因子：
7.2
通讯作者：
Heit, M
中科院分区：
文献类型：
--
作者：
Nygaard, IE;Heit, M
压力性尿失禁，在努力或行使过程中不自主泄漏的投诉，发生至少每周在三分之一的成年女性。压力性尿失禁的基本评估包括病史、体格检查、咳嗽压力试验、排尿日记、排尿后残余尿量和尿分析。正式的尿动力学检查可能有助于指导临床护理，但尿动力学检查是否能改善或预测尿失禁治疗的结果尚不清楚。尿动力学压力性尿失禁伴高活动性和尿动力学压力性尿失禁伴内括约肌功能不全之间的区别应被视为尿道功能的连续性，而不是二分法。初步治疗应包括行为改变和骨盆底肌肉训练。雌激素不适用于治疗压力性尿失禁。膀胱训练、阴道装置和尿道插入物也可以减少压力性尿失禁。填充剂可减少渗漏，但效果通常在1-2年后下降。外科手术比非外科手术更有可能治愈压力性尿失禁，但与更多的不良事件有关。根据目前的证据，阴道悬吊术（如Burch）和耻骨阴道吊带术（包括较新的尿道中段合成吊带）是最有效的手术治疗方法。(C)2004年由美国妇产科医师学会。
Stress urinary incontinence, the complaint of involuntary leakage during effort or exertion, occurs at least weekly in one third of adult women. The basic evaluation of women with stress urinary incontinence includes a history, physical examination, cough stress test, voiding diary, postvoid residual urine volume, and urinalysis. Formal urodynamics testing may help guide clinical care, but whether urodynamics improves or predicts the outcome of incontinence treatment is not yet clear. The distinction between urodynamic stress incontinence associated with hypermobility and urodynamic stress incontinence associated with intrinsic sphincter deficiency should be viewed as a continuum, rather than a dichotomy, of urethral function. Initial treatment should include behavioral changes and pelvic floor muscle training. Estrogen is not indicated to treat stress urinary incontinence. Bladder training, vaginal devices, and urethral inserts also may reduce stress incontinence. Bulking agents reduce leakage, but effectiveness generally decreases after 1-2 years. Surgical procedures are more likely to cure stress urinary incontinence than nonsurgical procedures but are associated with more adverse events. Based on available evidence at this time, colposuspension (such as Burch) and pubovaginal sling (including die newer midurethral synthetic slings) are the most effective surgical treatments. (C) 2004 by The American College of Obstetricians and Gynecologists.