Delancey John O L, Ashton-Miller James A
Department of Obstetrics and Gynecology, Institute of Gerontology, University of Michigan at Ann Arbor, 48109-0276, USA.
Gastroenterology. 2004 Jan;126(1 Suppl 1):S23-32. doi: 10.1053/j.gastro.2003.10.080.
The anatomic structures that prevent stress incontinence, urinary incontinence during elevations in abdominal pressure, can be divided into 2 systems: a sphincteric system and a supportive system. The action of the vesical neck and urethral sphincteric mechanisms at rest constrict the urethral lumen and keep urethral closure pressure higher than bladder pressure. The striated urogenital sphincter, the smooth muscle sphincter in the vesical neck, and the circular and longitudinal smooth muscle of the urethra all contribute to closure pressure. The mucosal and vascular tissues that surround the lumen provide a hermetic seal, and the connective tissues in the urethral wall also aid coaptation. Decreases in striated muscle sphincter fibers occur with age and parity, but the other tissues are not well understood. The supportive hammock under the urethra and vesical neck provides a firm backstop against which the urethra is compressed during increases in abdominal pressure to maintain urethral closure pressures above rapidly increasing bladder pressure. The stiffness of this supportive layer is presumed to be important to the degree to which compression occurs. This supporting layer consists of the anterior vaginal wall and the connective tissue that attaches it to the pelvic bones through the pubovaginal portion of the levator ani muscle and also the tendinous arch of the pelvic fascia. Activation of the levator muscle during abdominal pressurization is important to this stabilization process. The integrity of the connection between the vaginal wall and tendinous arch also plays an important role.
防止压力性尿失禁（即腹压升高时的尿失禁）的解剖结构可分为两个系统：括约肌系统和支持系统。膀胱颈和尿道括约肌机制在静息状态下的作用是收缩尿道管腔，使尿道闭合压高于膀胱压。横纹肌性泌尿生殖括约肌、膀胱颈的平滑肌括约肌以及尿道的环形和纵行平滑肌均有助于产生闭合压。围绕管腔的黏膜和血管组织形成密闭密封，尿道壁中的结缔组织也有助于贴合。横纹肌括约肌纤维会随着年龄增长和经产次数增加而减少，但其他组织的情况尚不清楚。尿道和膀胱颈下方的支持性吊带提供了一个坚实的支撑，在腹压增加时，尿道会受到挤压，从而使尿道闭合压保持在快速升高的膀胱压之上。据推测，该支持层的硬度对于挤压发生的程度很重要。这个支持层由阴道前壁以及通过耻骨直肠肌的耻骨阴道部分将其与骨盆骨相连的结缔组织和盆筋膜腱弓组成。在腹压增加时提肌的激活对这一稳定过程很重要。阴道壁与腱弓之间连接的完整性也起着重要作用。
