Meyer S, DeGrandi P, Schmidt N
Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Urology. 1991 Aug;38(2):157-60. doi: 10.1016/s0090-4295(05)80078-0.
The correlation between clinical and tonometric incontinence is frequently poor, with urethral profile results that do not correspond to clinical reality. Among potential causal factors, we have attempted to determine the importance of the absorption of kinetic energy from the mass of urine driven against the urethral captor (the hydraulic ram effect). Twenty patients (average age 50 +/- 10 years, para 2) suffering from genuine stress urinary incontinence, underwent urodynamic investigation with a constant air-flow pneumatic catheter equipped with two captors separated by an inflatable cuff located just above the urethral captor to block the inrush of urine into the urethra. After cystometric examination had excluded an unstable bladder, two urethral profiles were registered successively, first with cuff deflated, and then with cuff inflated. The values for urethral functional length (FL) and transmission factor (TF) show no significant changes. The values for the maximal urethral closing pressure (MUCP) were significantly lower in the second profile (cuff inflated) in 18 of 20 cases (average decrease 7 cm H2O), which corresponds to 14 percent of the average MUCP measured during the first profile (cuff deflated). The depression quotient increased from an average 0.80 to 1.05 from first to second profile. This study allows quantification of the urethral "hydraulic ram effect" which modifies determination of the MUCP during registration of urinary stress profile.
临床性尿失禁与眼压测量性尿失禁之间的相关性通常较差，尿道压力图结果与临床实际情况不符。在潜在的因果因素中，我们试图确定尿液质量冲击尿道感受器所吸收的动能（水锤效应）的重要性。20例真性压力性尿失禁患者（平均年龄50±10岁，经产2次），使用配备有两个感受器的恒流气动导管进行尿动力学检查，两个感受器之间由一个位于尿道感受器上方的可充气袖带隔开，以阻止尿液涌入尿道。在膀胱测压检查排除不稳定膀胱后，先后记录两次尿道压力图，第一次袖带放气，第二次袖带充气。尿道功能长度（FL）和传导因子（TF）的值无显著变化。20例中有18例在第二次压力图（袖带充气）时最大尿道闭合压（MUCP）值显著降低（平均降低7 cm H₂O），相当于第一次压力图（袖带放气）时测得的平均MUCP的14%。抑郁商从第一次压力图到第二次压力图平均从0.80增加到1.05。本研究能够对尿道“水锤效应”进行量化，该效应在记录尿动力学压力图时会改变MUCP的测定结果。
