de Aguiar Cavalcanti Geraldo, Manzano Gilberto Mastrocola, Nunes Karlo Faria, Giuliano Lydia Maria Pereira, de Menezes Tatiane Almeida, Bruschini Homero
Division of Urology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
Int Urogynecol J. 2013 May;24(5):801-7. doi: 10.1007/s00192-012-1931-8. Epub 2012 Sep 8.
Although still a matter of debate, stress urinary incontinence (SUI) may be accompanied by damage to urethral and pelvic floor innervations, thus promoting dysfunctions of the urethral support and sphincteric closure mechanisms. The aim of this study was to analyze the pelvic floor and urethral innervations through pelvic electrophysiological tests to identify whether neurological alterations interfere with urinary continence and urethral functional activity.
This prospective study included 52 women, 33 with clinically and urodynamically proven SUI and 19 continent volunteers matched for age, height, parity, and number of vaginal deliveries by the propensity score method. The patients were divided according to the severity of urinary loss evaluated by measuring abdominal leak point pressure (ALPP). Pudendal nerve terminal motor latency (PNTML), pudendal somatosensory evoked potential (SSEP) latencies, urethral and clitoral sensory thresholds, and urethroanal reflex latency were tested.
SUI and control subjects did not differ in PNTML, SSEP latency, and clitoral sensory thresholds. However, reduced responsiveness to urethral electrosensitivity and prolonged urethroanal reflex latency were detected in most incontinent patients. In addition, urethral electrosensitivity was altered in suspected intrinsic sphincteric dysfunction.
Urethral afferent pathways can be altered in women with SUI and may play an important role in evoking intrinsic sphincteric dysfunction.
尽管压力性尿失禁（SUI）是否伴有尿道及盆底神经损伤仍存在争议，但这种损伤可能会导致尿道支撑和括约肌关闭机制功能障碍。本研究旨在通过盆腔电生理测试分析盆底和尿道神经支配情况，以确定神经学改变是否会干扰尿失禁和尿道功能活动。
这项前瞻性研究纳入了52名女性，其中33名经临床和尿动力学证实患有SUI，19名年龄、身高、产次及阴道分娩次数相匹配的无尿失禁志愿者通过倾向评分法选取。根据通过测量腹压漏尿点压力（ALPP）评估的尿失禁严重程度对患者进行分组。测试了阴部神经终末运动潜伏期（PNTML）、阴部躯体感觉诱发电位（SSEP）潜伏期、尿道和阴蒂感觉阈值以及尿道肛门反射潜伏期。
SUI患者与对照组在PNTML、SSEP潜伏期和阴蒂感觉阈值方面无差异。然而，在大多数尿失禁患者中检测到尿道电敏感性反应降低和尿道肛门反射潜伏期延长。此外，在疑似内在括约肌功能障碍患者中尿道电敏感性发生改变。
SUI女性患者的尿道传入通路可能发生改变，并且可能在引发内在括约肌功能障碍中起重要作用。
