AN INTEGRAL THEORY OF FEMALE URINARY INCONTINENCE Experimental and clinical considerations
AN INTEGRAL THEORY OF FEMALE URINARY INCONTINENCE Experimental and clinical considerations
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DOI：
10.1111/j.1600-0412.1990.tb08027.x
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发表时间：
1990-01-01
影响因子：
4.3
通讯作者：
Ulmsten, Ulf I.
中科院分区：
文献类型：
--
作者：
Petros, Peter E. Papa;Ulmsten, Ulf I.
在这篇理论论文中，分析了女性泌尿系统中涉及的特定结构的复杂相互作用。此外，年龄，激素和医源性瘢痕组织对这些结构的影响，特别是讨论了解尿失禁治疗的适当基础。根据这一理论，压力和冲动症状可能都来自于同一个解剖缺陷，原因不同，阴道松弛。这种松弛可能是由阴道壁本身或其支撑结构（即韧带、肌肉及其结缔组织插入）内的缺陷引起的。阴道具有双重功能。它通过三种独立的闭合机制介导（传输）膀胱颈打开和闭合中涉及的各种肌肉运动。它还具有结构功能，并通过支持近端尿道和膀胱颈处的假设牵张感受器来防止尿急。阴道结缔组织和/或其韧带支撑中的胶原蛋白/弹性蛋白改变可能导致松弛。这消散了肌肉收缩，引起压力性尿失禁，和/或通过刺激膀胱基底牵张感受器激活不适当的排尿反射（膀胱不稳定性）。后者表现为频率，紧迫性，排尿困难伴或不伴尿量减少的症状。
In this Theory paper, the complex interplay of the specific structures involved in female urinary continence are analyzed. In addition the effects of age, hormones, and iatrogenically induced scar tissue on these structures, are discussed specifically with regard to understanding the proper basis for treatment of urinary incontinence. According to the Theory stress and urge symptoms may both derive, for different reasons from the same anatomical defect, a lax vagina. This laxity may be caused by defects within the vaginal wall itself, or its supporting structures i.e. ligaments, muscles, and their connective tissue insertions. The vagina has a dual function. It mediates (transmits) the various muscle movements involved in bladder neck opening and closure through three separate closure mechanisms. It also has a structural function, and prevents urgency by supporting the hypothesized stretch receptors at the proximal urethra and bladder neck. Altered collagen/elastin in the vaginal connective tissue and/or its ligamentous supports may cause laxity. This dissipates the muscle contraction, causing stress incontinence, and/or activation of an inappropriate micturition reflex, (bladder instability) by stimulation of bladder base stretch receptors. The latter is manifested by symptoms of frequency, urgency, nocturia with or without urine loss.