Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, University of Leuven, Herestraat 49, Leuven 3000, Belgium.
Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium.
Nat Rev Urol. 2017 Jun;14(6):373-385. doi: 10.1038/nrurol.2017.42. Epub 2017 Apr 4.
With advancing population age, pelvic-floor dysfunction (PFD) will affect an increasing number of women. Many of these women wish to maintain active lifestyles, indicating an urgent need for effective strategies to treat or, preferably, prevent the occurrence of PFD. Childbirth and pregnancy have both long been recognized as crucial contributing factors in the pathophysiology of PFD. Vaginal delivery of a child is a serious traumatic event, causing anatomical and functional changes in the pelvic floor. Similar changes to those experienced during childbirth can be found in symptomatic women, often many years after delivery. Thus, women with such PFD symptoms might have incompletely recovered from the trauma caused by vaginal delivery. This hypothesis creates the possibility that preventive measures can be initiated around the time of delivery. Secondary prevention has been shown to be beneficial in patients with many other chronic conditions. The current general consensus is that clinicians should aim to minimize the extent of damage during delivery, and aim to optimize healing processes after delivery, therefore preventing later dysfunction. A substantial amount of research investigating the potential of stem-cell injections as a therapeutic strategy for achieving this purpose is currently ongoing. Data from small animal models have demonstrated positive effects of mesenchymal stem-cell injections on the healing process following simulated vaginal birth injury.
随着人口老龄化的推进，盆底功能障碍（PFD）将影响越来越多的女性。这些女性中的许多人希望保持积极的生活方式，这表明迫切需要有效的策略来治疗，或者最好是预防 PFD 的发生。分娩和妊娠一直被认为是 PFD 病理生理学的重要致病因素。阴道分娩是一个严重的创伤事件，导致盆底的解剖和功能发生变化。在有症状的女性中，可以发现与分娩时相似的变化，通常在分娩后多年。因此，有此类 PFD 症状的女性可能尚未从阴道分娩造成的创伤中完全恢复。这一假设为分娩时可以开始采取预防措施创造了可能性。二级预防已被证明对许多其他慢性疾病患者有益。目前的普遍共识是，临床医生应尽量减少分娩过程中的损伤程度，并在分娩后优化愈合过程，从而预防后期功能障碍。目前正在进行大量研究，探讨干细胞注射作为实现这一目标的治疗策略的潜力。来自小动物模型的数据表明，间充质干细胞注射对模拟阴道分娩损伤后的愈合过程有积极影响。
