Stress incontinence and biophysical properties : Shear strength of the anterior vaginal wall and contractile strength of the pelvic floor muscles.

研究目的：研究阴道前壁和直肌的生物物理特性，它们与压力性尿失禁和排尿时中断尿流的能力密切相关。阴道前壁和直肌筋膜的剪切强度通过穿过连接到数字测力计的Stamey针来评估，26名患有压力性尿失禁的女性和21名接受子宫肌瘤手术的对照女性。两组均在手术室记录数值。至于中断的尿流，73失禁妇女和42个大陆妇女招募了这项评估。指导它们在排尿期间中断流2至3次，持续3至5秒。结果：尿失禁患者阴道壁和腹直肌筋膜的抗剪强度明显低于正常对照组（P<0.01），尿失禁患者阴道壁和腹直肌筋膜的抗剪强度明显低于正常对照组（P<0.01）。在36%的尿失禁患者和76%的尿失禁患者中观察到血流完全中断（p=0.002）。在结束的骨盆底运动63%的那些谁受益于运动和50%的那些谁没有可以完全中断流（p=0.95）。结论：通过剪切强度的重要组织的结果表明，一些妇女患有压力性尿失禁可能有遗传性疾病的生物物理特性的组织。虽然大多数失禁的妇女不能中断流，尿失禁是不是维持单纯的收缩力量的骨盆底肌肉。失眠是一种多因素的疾病。

AIMES OF THE STUDY : To investigate biophysical properties of the anterior vaginal wall and the rectus muscle which are closely related to stress incontinence and abilities to interrupt the urinary stream during voiding.PATIENTS AND METHODS : Shear strength of the anterior vaginal wall and the rectus fascia was evaluated by passing a Stamey's needle, which was connected to a digital force gauge, in 26 women suffering from stress incontinence and 21 control women who were to be operated on for uterine myoma. Values were recorded in an operation theater in both groups. As for interruption of the urinary stream 73 incontinent women and 42 continent women were recruited for this assessment. They were instructed to interrupt the stream for 3 to 5 sec 2 to 3 times during their micturition. Relationship between treatment effects of the pelvic floor exercise and abilities to interrupt the stream was also evaluated in 18 incontinent women.RESULTS : Shear strength of the vaginal wall and the rectus fascia was lower in incontinent patients than in continent subjects (p<0.01). Complete interruption of the stream was observed in 36% of those with incontinence and 76% of those with continence (p=0.002). At the end of the pelvic floor exercise 63% of those who were benefitted from the exercise and 50% of those who were not could completely interrupt the stream (p=0.95).CONCLUSION : The results obtained through shear strength of the vital tissues suggest that some women suffering from stress incontinence may have a hereditary disorder of biophysical properties of the tissues. Though majority of incontinent women can not interrupt the stream, urinary continence is not maintained solely by contractile strength of the pelvic floor muscles. Incontinence is really a multi-factorial disease.