Schwenzer T, Schwenzer C, Schwenzer M
Universitätsfrauenklinik Düsseldorf.
Geburtshilfe Frauenheilkd. 1989 Oct;49(10):857-64. doi: 10.1055/s-2008-1036100.
In 555 stress-induced urinary incontinent and 119 continent women patients, we studied the history, clinical and urodynamic investigations to define the hypotonic urethra and to find out important etiological factors of the low urethral closure pressure. The linear depression of the urethral pressure and the urethral closure pressure at rest--well known from literature--has been confirmed in this study. With hypotonic urethra, closure pressure values were found to be below the simple standard deviation from a norm-curve. Also, in cases of stress urinary incontinence, we found a nearly linear depression of closure pressure. The stress incontinent patients could be divided in two groups: 46% with hypotonic urethra, 54% with nearly normal closure pressure. History of former incontinence surgery, but also of other operations such as simple abdominal or vaginal hysterectomy, is correlated with low urethral closure pressure. The degree of closure pressure is correlated with shortening of the functional urethral length. The maximum closure pressure shifts distally. Women, who, despite hypotonic urethras, are continent, build up a positive closure pressure throughout a broad zone of the functional urethral length. Contrarily, in the case of incontinent patients, even a weak coughing spasm, which does not even break through the bladder sphincter in maximum closure, can cause opening of the urethra and establishment of pressure equilibration between bladder and urethra.
在555例压力性尿失禁女性患者和119例尿控正常的女性患者中，我们研究了病史、临床及尿动力学检查结果，以明确尿道低张状态，并找出尿道闭合压降低的重要病因。本研究证实了文献中所熟知的尿道压力及静息时尿道闭合压的线性降低。对于尿道低张的患者，其闭合压值低于正常曲线的简单标准差。此外，在压力性尿失禁患者中，我们也发现了闭合压近乎线性的降低。压力性尿失禁患者可分为两组：46%为尿道低张，54%的尿道闭合压近乎正常。既往尿失禁手术史，以及其他手术史，如单纯腹部或阴道子宫切除术，均与尿道闭合压降低相关。闭合压程度与功能性尿道长度缩短相关。最大闭合压向远端移位。尽管尿道低张但仍能控尿的女性，在功能性尿道长度的广泛区域内可形成正性闭合压。相反，在尿失禁患者中，即使是轻微的咳嗽痉挛，在最大闭合时甚至不会突破膀胱括约肌，也可导致尿道开放，并使膀胱与尿道之间建立压力平衡。
