Serati Maurizio, Salvatore Stefano, Uccella Stefano, Cromi Antonella, Khullar Vik, Cardozo Linda, Bolis Pierfrancesco
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Piazza Biroldi 1, Varese, Italy.
Eur Urol. 2008 Oct;54(4):911-5. doi: 10.1016/j.eururo.2007.11.008. Epub 2007 Nov 20.
To understand the pathophysiological mechanism of incontinence during orgasm and to compare women affected by symptomatic detrusor overactivity (DO) with and without incontinence at orgasm in terms of efficacy of antimuscarinic treatment.
All consecutive sexually active women with incontinence during intercourse were prospectively included and divided into two groups: women with coital incontinence at orgasm or at penetration. The two forms of coital incontinence were correlated to the urodynamic finding of DO. Women complaining of overactive bladder (OAB) symptoms, with urinary incontinence at orgasm and urodynamically proven DO (cases), were prescribed tolterodine 4 mg extended release for at least 12 wk. The cases were compared in terms of efficacy of treatment on OAB symptoms to consecutive patients with symptomatic DO without coital incontinence (control group).
Among the 1133 women who underwent urodynamic testings during the study period, 132 patients were eligible for final analysis. A significant difference in DO was observed in women with incontinence at orgasm (34 of 49; 69.4%) compared with women with incontinence during penetration (24 of 83; 28.9%) (p<0.0001). The 34 women with incontinence at orgasm associated with DO were given antimuscarinics treatment and were compared with 53 controls. Fourteen of 34 (41.2%) and 9 of 53 (17%) women did not respond to antimuscarinics in the cases and in the control group, respectively (p=0.023).
Incontinence at orgasm is associated with DO in the majority of cases. This is the first study showing an inferior efficacy of antimuscarinic treatment in women with DO complaining of incontinence at orgasm.
了解性高潮期尿失禁的病理生理机制，并比较有症状的逼尿肌过度活动（DO）且性高潮期有无尿失禁的女性在抗毒蕈碱治疗效果方面的差异。
前瞻性纳入所有在性交期间出现尿失禁的连续有性活动的女性，并将其分为两组：性高潮期或插入时出现性交性尿失禁的女性。这两种性交性尿失禁形式与DO的尿动力学检查结果相关。主诉膀胱过度活动症（OAB）症状、性高潮期尿失禁且尿动力学证实为DO的女性（病例组），给予4毫克缓释托特罗定治疗至少12周。将病例组在OAB症状治疗效果方面与连续的有症状DO但无性交性尿失禁的患者（对照组）进行比较。
在研究期间接受尿动力学检查的1133名女性中，132名患者符合最终分析条件。性高潮期尿失禁的女性中DO的发生率（49例中的34例；69.4%）与插入时尿失禁的女性（83例中的24例；28.9%）相比有显著差异（p<0.0001）。34例性高潮期尿失禁且与DO相关的女性接受了抗毒蕈碱治疗，并与53名对照组进行比较。病例组和对照组中分别有14/34（41.2%）和9/53（17%）的女性对抗毒蕈碱治疗无反应（p=0.023）。
大多数情况下，性高潮期尿失禁与DO相关。这是第一项表明抗毒蕈碱治疗对主诉性高潮期尿失禁的DO女性疗效较差的研究。
