Cour F, Le Normand L, Lapray J-F, Hermieu J-F, Peyrat L, Yiou R, Donon L, Wagner L, Vidart A
Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Université de Versailles-Saint-Quentin-en-Yvelines, 55, avenue de Paris, 78035 Versailles cedex, France.
Service d'urologie, CHU de Nantes, place A.-Ricordeau, 44093 Nantes cedex 01, France.
Prog Urol. 2015 Jun;25(8):437-54. doi: 10.1016/j.purol.2015.03.006. Epub 2015 Apr 9.
Stress urinary female incontinence (SUI) is primary due to intrinsic sphincter deficiency (ISD) and urethral hypermobility. Despite a lack of standardised international definition, ISD needs to be clearly diagnosed in order to be correctly treated. This work is an update about the female ISD produced from a review of a published article.
This review of article published on this subject in the Medline (Pubmed database), selected according to their scientific relevants, of consensus conferences and published guidelines, has been performed by the committee for women pelvic floor surgery of the French Urological Association.
Although there is no international consensus definition, we can consider that the ISD is a composite concept combining urodynamic data (MUCP < 20 or 30 cmH20) and one or more clinical information (no urethral mobility, negative urethral support test, failure of a first surgery, leakage during abdominal straining, high stress incontinence scores). Imaging can provide additional evidence for intrinsic sphincter deficiency diagnosis, but the correlation between imaging and function remains low. By standardizing methodology and interpretations to better diagnose women with ISD, it may be possible to improve preoperative planning and outcomes for these patients. A retropubic midurethral sling can be performed as a first surgery. In case of a lack of urethral mobility, the artificial urinary sphincter (AUS) remains the gold standard. Adjustable continence therapy (ACT(®)) can be proposed as an alternative option. The efficacy and safety of muscle-derived cell therapy in ISD needs more studies. Injection of bulking agents may be an option according to the severity and the expectations of the patient. Bladder overactivity needs to be treated as first-line in case of mixed urinary incontinence. In elderly women, a careful evaluation of the bladder contractility and comorbidity must be performed. A geriatric evaluation can be necessary.
Clinical and paraclinical assessment allow to confirm the diagnosis of female ISD, to estimate its severity, and to identify associated mechanisms of incontinence (urethral hypermobility, bladder overactivity) to choose the most adapted treatment.
压力性尿失禁（SUI）主要归因于内在括约肌缺陷（ISD）和尿道活动过度。尽管缺乏标准化的国际定义，但为了进行正确治疗，仍需要明确诊断ISD。本文是对已发表文章进行综述后得出的关于女性ISD的最新内容。
法国泌尿外科学会女性盆底手术委员会对Medline（PubMed数据库）上发表的关于该主题的文章进行了综述，这些文章是根据其科学相关性、共识会议和已发表的指南挑选出来的。
尽管尚无国际共识定义，但我们可以认为ISD是一个综合概念，结合了尿动力学数据（最大尿道闭合压<20或30 cmH₂O）和一个或多个临床信息（无尿道活动、尿道支持试验阴性、首次手术失败、腹部用力时漏尿、高压力性尿失禁评分）。影像学检查可为内在括约肌缺陷的诊断提供额外证据，但影像学与功能之间的相关性仍然较低。通过标准化方法和解释以更好地诊断ISD女性患者，可能会改善这些患者的术前规划和治疗效果。耻骨后尿道中段吊带术可作为首选手术。如果尿道活动不足，人工尿道括约肌（AUS）仍是金标准。可提议采用可调节控尿疗法（ACT(®)）作为替代方案。肌肉来源细胞疗法在ISD中的疗效和安全性需要更多研究。根据患者的严重程度和期望，注射填充剂可能是一种选择。对于混合性尿失禁，膀胱过度活动症需作为一线治疗。对于老年女性，必须仔细评估膀胱收缩力和合并症。可能需要进行老年医学评估。
临床和辅助检查评估有助于确诊女性ISD，评估其严重程度，并识别尿失禁的相关机制（尿道活动过度、膀胱过度活动），从而选择最适合的治疗方法。
