Ragni E, Lousquy R, Costa P, Delmas V, Haab F
Service d'urologie, hôpital Nord, AP-HM, France.
Prog Urol. 2009 Dec;19(13):932-8. doi: 10.1016/j.purol.2009.09.021. Epub 2009 Nov 4.
Numerous epidemiological studies in recent years have involved the search for the principal risk factors of genitourinary prolapse. Although it has been agreed for a long time that vaginal delivery increases the risk of prolapse (proof level 1), on the other hand, the Cesarian section cannot be considered a completely effective preventative method (proof level 2). The pregnancy itself is a risk factor for prolapse (proof level 2). Certain obstetrical conditions contribute to the alterations of the perineal floor muscle: a foetus weighing more than four kilos, the use of instruments at birth (proof level 3). If the risk of prolapse increases with age, intrication with hormonal factors is important (proof level 2). The role of hormonal replacement therapy remains controversial. Antecedent pelvic surgery has also been identified as a risk factor (proof level 2). Other varying acquired factors have been documented. Obesity (BMI and abdominal perimeter), professional activity and intense physical activity (proof level 3), as well as constipation, increase the risk of prolapse. More thorough research into these varying factors is necessary in order to be able to argue for measures of prevention, obstetrical techniques having already evolved to ensure minimal damage to the perineal structure.
近年来，众多流行病学研究致力于探寻泌尿生殖系统脱垂的主要风险因素。尽管长期以来人们一致认为经阴道分娩会增加脱垂风险（证据等级为1级），但另一方面，剖宫产不能被视为一种完全有效的预防方法（证据等级为2级）。妊娠本身就是脱垂的一个风险因素（证据等级为2级）。某些产科情况会导致会阴盆底肌肉发生改变：胎儿体重超过4千克、分娩时使用器械（证据等级为3级）。如果脱垂风险随年龄增长而增加，那么与激素因素的关联就很重要（证据等级为2级）。激素替代疗法的作用仍存在争议。既往盆腔手术也已被确定为一个风险因素（证据等级为2级）。其他各种后天因素也有记录。肥胖（体重指数和腹围）、职业活动和剧烈体育活动（证据等级为3级）以及便秘都会增加脱垂风险。为了能够提出预防措施，有必要对这些不同因素进行更深入的研究，因为产科技术已经发展，以确保对会阴结构的损伤最小化。
