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，这些特性与压力性尿失禁和排尿时尿流中断的能力密切相关。患者和方法：对26例因子宫肌瘤而行手术的压力性尿失禁患者和21例对照组患者，通过与数字力计连接的Stamey针，评估阴道前壁和直肌筋膜的剪切强度。两组均在同一手术室进行数值记录。至于尿流中断，我们招募了73名失禁妇女和42名无尿障碍妇女进行这项评估。他们被指示在排尿时中断流3到5秒2到3次。在18名失禁妇女中，还评估了骨盆底运动的治疗效果和中断流的能力之间的关系。结果：尿失禁组阴道壁和直肌筋膜剪切强度低于尿失禁组（p<0.01）。36%的失禁患者和76%的失禁患者尿流完全中断（p=0.002）。在骨盆底运动结束时，63%的人从运动中受益，50%的人没有运动，可以完全中断流（p=0.95）。结论：通过对重要组织剪切强度的测定结果提示，一些女性应力性尿失禁可能存在组织生物物理特性的遗传性疾病。虽然大多数失禁的妇女不能中断流，尿失禁并不仅仅是维持盆底肌肉的收缩力量。尿失禁是一种多因素疾病。

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.