Heesakkers John, Gerretsen Reza, Izeta Ander, Sievert Karl-Dietrich, Farag Fawzy
Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, The Netherlands.
Neurourol Urodyn. 2016 Feb;35(2):186-91. doi: 10.1002/nau.22711. Epub 2014 Dec 18.
The diagnosis of intrinsic sphincter deficiency (ISD) in patients with stress urinary incontinence (SUI) is not well established. We explored the possibility of applying a new tool: minimally invasive circumferential sphincter surface electromyography (CSS-EMG) to assess the muscular integrity of the urethral sphincter in patients with SUI/ISD.
CSS-EMG of the urethral sphincter and urodynamic studies were performed in 44 women with SUI. A urethral pressure profile (UPP) was measured in four directions. Maximal urethral closure pressure (MUCP) <40 cm/H2 O or the presence of SUI without urethral hypermobility was used to define ISD.
Twenty-one patients had urodynamic SUI, 23 had no SUI and 12 patients had ISD. The mean average rectified value (ARV) of the motor unit action potential (MUAP), an indicator of the strength of urethral rhabdosphincter, was estimated. ARV measured in the 12 o'clock quadrant during maximal contraction was the only CSS-EMG parameter that had significant predictive value for ISD. With an increase in the 12 o'clock ARV value, the likelihood of ISD decreases (Odds Ratio 0.36 95% confidence interval 0.67-0.92). In the ROC curve with ARV measured in the 12 o'clock quadrant during maximal contraction, the explained area was 0.794 (P = 0.02); implying that ARV measured at the 12 o'clock quadrant during maximal contraction was able to predict ISD significantly.
Myogenic changes of the urethral sphincter that contribute to ISD can be assessed with CSS-EMG. This new concept for assessing the functionality of the female urethral sphincter may assist with better understanding of the pathophysiology, the diagnosis and the treatment of SUI.
压力性尿失禁（SUI）患者内在括约肌缺陷（ISD）的诊断尚未明确。我们探讨了应用一种新工具：微创环形括约肌表面肌电图（CSS-EMG）来评估SUI/ISD患者尿道括约肌肌肉完整性的可能性。
对44例SUI女性患者进行尿道括约肌CSS-EMG检查和尿动力学研究。在四个方向测量尿道压力轮廓（UPP）。最大尿道闭合压（MUCP）<40 cm/H₂O或存在无尿道活动过度的SUI被用于定义ISD。
21例患者有尿动力学SUI，23例无SUI，12例患者有ISD。估计了运动单位动作电位（MUAP）的平均整流值（ARV），这是尿道横纹括约肌强度的指标。最大收缩时在12点象限测量的ARV是唯一对ISD有显著预测价值的CSS-EMG参数。随着12点ARV值的增加，ISD的可能性降低（优势比0.36，95%置信区间0.67-0.92）。在最大收缩时12点象限测量ARV的ROC曲线中，解释面积为0.794（P = 0.02）；这意味着最大收缩时在12点象限测量的ARV能够显著预测ISD。
可通过CSS-EMG评估导致ISD的尿道括约肌肌源性变化。这种评估女性尿道括约肌功能的新概念可能有助于更好地理解SUI的病理生理学、诊断和治疗。
