Tawadros Cecile, Burnett Katherine, Derbyshire Laura F, Tawadros Thomas, Clarke Noel W, Betts Christopher D
Department of Urology, Salford Royal NHS Foundation Trust, Salford, UK.
Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
BJU Int. 2015 Sep;116(3):423-31. doi: 10.1111/bju.13042. Epub 2015 May 4.
To investigate by electromyography (EMG), the presence of complex repetitive discharges (CRDs) and decelerating bursts (DBs) in the striated external urethral sphincter during the menstrual cycle in female volunteers with no urinary symptoms and complete bladder emptying.
Healthy female volunteers aged 20-40 years, with regular menstrual cycles and no urinary symptoms were recruited. Volunteers completed a menstruation chart, urinary symptom questionnaires, pregnancy test, urine dipstick, urinary free flow and post-void ultrasound bladder scan. Exclusion criteria included current pregnancy, use of hormonal medication or contraception, body mass index of >35 kg/m(2) , incomplete voiding and a history of pelvic surgery. Eligible participants underwent an external urethral sphincter EMG, using a needle electrode in the early follicular phase and the mid-luteal phase of their menstrual cycles. Serum oestradiol and progesterone were measured at each EMG test.
In all, 119 women enquired about the research and following screening, 18 were eligible to enter the study phase. Complete results were obtained in 15 women. In all, 30 EMG tests were undertaken in the 15 asymptomatic women. Sphincter EMG was positive for CRDs and DBs at one or both phases of the menstrual cycle in eight (53%) of the women. Three had CRDs and DBs in both early follicular and mid-luteal phases. Five had normal EMG activity in the early follicular phase and CRDs and DBs in the mid-luteal phase. No woman had abnormal EMG activity in the early follicular phase and normal activity in the luteal phase. There was no relationship between EMG activity and age, parity or serum levels of oestradiol and progesterone.
CRDs and DB activity in the external striated urethral sphincter is present in a high proportion of asymptomatic young women. This abnormal EMG activity has been shown for the first time to change during the menstrual cycle in individual women. CRDs and DBs are more commonly found in the luteal phase of the menstrual cycle. The importance of CRDs and DBs in the aetiology of urinary retention in young women remains uncertain. The distribution and or quantity of abnormal EMG activity in the external urethral sphincter may be important. In a woman with urinary retention the finding of CRDs and DBs by needle EMG does not automatically establish Fowler's syndrome as the explanation for the bladder dysfunction. Urethral pressure profilometry may be helpful in establishing a diagnosis. Opiate use and psychological stress should be considered in young women with urinary retention.
通过肌电图（EMG）研究无排尿症状且膀胱完全排空的女性志愿者在月经周期中尿道外横纹括约肌是否存在复合重复放电（CRDs）和减速爆发（DBs）。
招募年龄在20 - 40岁、月经周期规律且无排尿症状的健康女性志愿者。志愿者完成月经图表、排尿症状问卷、妊娠试验、尿试纸检测、自由尿流测定及排尿后膀胱超声扫描。排除标准包括当前妊娠、使用激素药物或避孕措施、体重指数>35 kg/m²、排尿不完全及盆腔手术史。符合条件的参与者在月经周期的卵泡早期和黄体中期使用针电极进行尿道外括约肌肌电图检查。每次肌电图检查时测定血清雌二醇和孕酮水平。
共有119名女性咨询该研究，经过筛选，18名符合条件进入研究阶段。15名女性获得了完整结果。这15名无症状女性共进行了30次肌电图检查。在8名（53%）女性中，尿道外括约肌肌电图在月经周期的一个或两个阶段出现CRDs和DBs呈阳性。3名女性在卵泡早期和黄体中期均出现CRDs和DBs。5名女性在卵泡早期肌电图活动正常，而在黄体中期出现CRDs和DBs。没有女性在卵泡早期肌电图活动异常而在黄体期活动正常。肌电图活动与年龄、产次或血清雌二醇和孕酮水平之间无相关性。
无症状年轻女性中很大一部分尿道外横纹括约肌存在CRDs和DB活动。首次证明这种异常肌电图活动在个体女性月经周期中会发生变化。CRDs和DBs在月经周期的黄体期更常见。CRDs和DBs在年轻女性尿潴留病因中的重要性仍不确定。尿道外括约肌异常肌电图活动的分布和/或数量可能很重要。在尿潴留女性中，通过针电极肌电图发现CRDs和DBs并不能自动将福勒综合征作为膀胱功能障碍的解释。尿道压力测定可能有助于确诊。对于尿潴留的年轻女性，应考虑使用阿片类药物和心理压力因素。
