Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Int J Urol. 2012 Jun;19(6):524-37. doi: 10.1111/j.1442-2042.2012.02976.x. Epub 2012 Mar 9.
Stress urinary incontinence is the most common type of urinary incontinence in women. Stress urinary incontinence involves involuntary leakage of urine in response to abdominal pressure caused by activities, such as sneezing and coughing. The condition affects millions of women worldwide, causing physical discomfort as well as social distress and even social isolation. This type of incontinence is often seen in women after middle age and it can be caused by impaired closure mechanisms of the urethra as a result of a weak pelvic floor or poorly supported urethral sphincter (urethral hypermobility) and/or a damaged urethral sphincter system (intrinsic sphincter deficiency). Until recently, stress urinary incontinence has been approached by clinicians as a purely anatomic problem as a result of urethral hypermobility requiring behavioral or surgical therapy. However, intrinsic sphincter deficiency has been reported to be more significantly associated with stress urinary incontinence than urethral hypermobility. Extensive basic and clinical research has enhanced our understanding of the complex neural circuitry regulating normal function of the lower urinary tract, as well as the pathophysiological mechanisms that might underlie the development of stress urinary incontinence and lead to the development of potential novel strategies for pharmacotherapy of stress urinary incontinence. Therapeutic targets include adrenergic and serotonergic receptors in the spinal cord, and adrenergic receptors at the urethral sphincter, which can enhance urethral reflex activity during stress conditions and increase baseline urethral pressure, respectively. This article therefore reviews the recent advances in stress urinary incontinence research and discusses the neurophysiology of urethral continence reflexes, the etiology of stress urinary incontinence and potential targets for pharmacotherapy of stress urinary incontinence.
压力性尿失禁是女性最常见的尿失禁类型。压力性尿失禁涉及在活动（如打喷嚏和咳嗽）引起的腹部压力下不自主地漏尿。这种情况影响了全球数以百万计的女性，导致身体不适，以及社交痛苦，甚至社交隔离。这种类型的失禁在中年后女性中很常见，它可能是由于尿道关闭机制受损，导致骨盆底虚弱或尿道括约肌支撑不良（尿道过度活动）和/或尿道括约肌系统受损（固有括约肌缺陷）。直到最近，由于尿道过度活动导致的压力性尿失禁一直被临床医生视为纯粹的解剖问题，需要行为或手术治疗。然而，固有括约肌缺陷与压力性尿失禁的相关性比尿道过度活动更为显著。广泛的基础和临床研究增强了我们对调节下尿路正常功能的复杂神经回路以及可能导致压力性尿失禁发展的病理生理机制的理解，并为压力性尿失禁的药物治疗开发潜在的新策略提供了依据。治疗靶点包括脊髓中的肾上腺素能和 5-羟色胺能受体，以及尿道括约肌中的肾上腺素能受体，它们分别可以在压力条件下增强尿道反射活动，并分别增加基线尿道压力。因此，本文综述了压力性尿失禁研究的最新进展，并讨论了尿道节制反射的神经生理学、压力性尿失禁的病因以及药物治疗压力性尿失禁的潜在靶点。
