Kessler Thomas M, Studer Urs E, Burkhard Fiona C
Department of Urology, University of Bern, 3010 Bern, Switzerland.
Neurourol Urodyn. 2007;26(2):208-12. doi: 10.1002/nau.20356.
To identify factors that potentially influence urethral sensitivity in women.
The current perception threshold was measured by double ring electrodes in the proximal and distal urethra in 120 women. Univariate analysis using Kaplan-Meier models and multivariate analysis applying Cox regressions were performed to identify factors influencing urethral sensitivity in women.
In univariate and multivariate analysis, women who had undergone radical pelvic surgery (radical cystectomy n = 12, radical rectal surgery n = 4) showed a significantly (log rank test P < 0.0001) increased proximal urethral sensory threshold compared to those without prior surgery (hazard ratio (HR) 4.17, 95% confidence interval (CI) 2.04-8.51), following vaginal hysterectomy (HR 4.95, 95% CI 2.07-11.85), abdominal hysterectomy (HR 5.96, 95% CI 2.68-13.23), or other non-pelvic surgery (HR 4.86, 95% CI 2.24-10.52). However, distal urethral sensitivity was unaffected by any form of prior surgery. Also other variables assessed, including age, concomitant diseases, urodynamic diagnoses, functional urethral length, and maximum urethral closure pressure at rest had no influence on urethral sensitivity in univariate as well as in multivariate analysis.
Increased proximal but unaffected distal urethral sensory threshold after radical pelvic surgery in women suggests that the afferent nerve fibers from the proximal urethra mainly pass through the pelvic plexus which is prone to damage during radical pelvic surgery, whereas the afferent innervation of the distal urethra is provided by the pudendal nerve. Better understanding the innervation of the proximal and distal urethra may help to improve surgical procedures, especially nerve sparing techniques.
确定可能影响女性尿道敏感性的因素。
使用双环电极测量了120名女性近端和远端尿道的当前感觉阈值。采用Kaplan-Meier模型进行单因素分析，并应用Cox回归进行多因素分析，以确定影响女性尿道敏感性的因素。
在单因素和多因素分析中，与未接受过手术的女性相比，接受过根治性盆腔手术（根治性膀胱切除术n = 12，根治性直肠手术n = 4）的女性近端尿道感觉阈值显著升高（对数秩检验P < 0.0001）（风险比（HR）4.17，95%置信区间（CI）2.04 - 8.51），在接受阴道子宫切除术后（HR 4.95，95% CI 2.07 - 11.85）、腹部子宫切除术后（HR 5.96，95% CI 2.68 - 13.23）或其他非盆腔手术术后（HR 4.86，95% CI 2.24 - 10.52）亦是如此。然而，远端尿道敏感性不受任何形式的既往手术影响。在单因素和多因素分析中，评估的其他变量，包括年龄、伴随疾病、尿动力学诊断、功能性尿道长度和静息时最大尿道闭合压，对尿道敏感性均无影响。
女性根治性盆腔手术后近端尿道感觉阈值升高而远端未受影响，这表明来自近端尿道的传入神经纤维主要通过盆腔丛，而盆腔丛在根治性盆腔手术中容易受损，而远端尿道的传入神经支配由阴部神经提供。更好地了解近端和远端尿道的神经支配可能有助于改进手术操作，尤其是保留神经技术。
