Petros Peter
University of Western Australia, Perth, Australia Professorial Department of Surgery University of NSW St. Vincent's Hospital Sydney, Australia.
Cent European J Urol. 2018;71(1):105-107. doi: 10.5173/ceju.2017.1597. Epub 2017 Dec 7.
The International Continence Society (ICS) committee has defined overactive bladder (OAB) as "a syndrome characterized by symptoms of urgency, with or without urgency incontinence, usually with increased daytime frequency and nocturia (increased night time urination). The term OAB can only be used if there is no proven infection or other obvious pathology". Though the ICS gives no anatomical basis for OAB, it is suggested that the cause is from the detrusor itself. In this review, urodynamic evidence is presented that OAB in the female may be a prematurely activated but normal micturition reflex, as predicted by the Integral Theory. Anatomically, a trampoline analogy explains how loose ligaments prevent the vaginal stretching so important for support of the bladder base stretch receptors which control the reflex. Surgical cure of OAB by repair of loose cardinal/ uterosacral ligaments are an important proof that the origins of OAB are outside the bladder, laxity of the suspensory ligaments which in turn, inactivate the striated muscle vector forces which contract against them. This concept is not in in conflict with the definitions of the ICS. Rather it provides a causative anatomical background to the definitions.
国际尿控协会（ICS）委员会将膀胱过度活动症（OAB）定义为“一种以尿急症状为特征的综合征，伴有或不伴有急迫性尿失禁，通常白天排尿频率增加和夜尿增多（夜间排尿次数增加）。只有在没有证实感染或其他明显病理状况时，才能使用OAB这个术语”。尽管ICS没有为OAB提供解剖学依据，但有人认为其病因来自逼尿肌本身。在本综述中，提出了尿动力学证据，表明女性的OAB可能是一种过早激活但正常的排尿反射，正如整体理论所预测的那样。从解剖学角度来看，蹦床类比解释了松弛的韧带如何阻止阴道伸展，而阴道伸展对于支撑控制反射的膀胱底部牵张感受器非常重要。通过修复松弛的主韧带/子宫骶韧带对OAB进行手术治疗，有力地证明了OAB的起源在膀胱之外，即悬韧带松弛，进而使对抗它们的横纹肌向量力失活。这一概念与ICS的定义并不冲突。相反，它为这些定义提供了一个病因学解剖学背景。
