Addington W Robert, Stephens Robert E, Miller Stuart P
Brevard Electrodiagnostic Medicine, Melbourne, FL, USA.
Department of Anatomy, Kansas City University of Medicine and Biosciences, Kansas City, MO, USA.
Cent European J Urol. 2019;72(4):378-383. doi: 10.5173/ceju.2019.1986. Epub 2019 Nov 25.
Voluntary cough (VC) and the laryngeal expiration reflex (LER) provoke stress urinary incontinence (SUI). The aim of this article is to analyze the effectiveness of these stimuli on the timing of urinary leaks.
Urodynamic testing using pressure catheters was performed on 123 subjects with history of SUI. The LER was triggered using the induced reflex cough test (iRCT). Each subject was tested with VC and LER and leaked with one or both stimuli. The occurrence and timing of leaks were recorded.
The peak and average intra-abdominal pressures were 16-19% greater for LER compared to VC. Of the 123 subjects, LER caused leak in 118 (96%), VC in 71 (58%) and both in 66 (54%). For LER compared to VC, leak was more likely to occur during or immediately after the first expiratory effort. The electromyogram for VC and LER were similar.
The iRCT reliably initiated the LER and triggered SUI more effectively than VC. During VC, the smooth muscle of the internal urethral sphincter (IUS) starts to contract during inspiration, and constriction of the IUS continues into the expiratory phase; this increased urethral tonicity would lessen the likelihood of SUI. We refer to this as the inspiration closure reflex (ICR). With LER the inspiration would not take place, and the first expiratory effort would be against a non-constricted IUS, making leak more likely. Our findings disprove the pressure transmission theory. The internal and external urethral sphincters may both increase urethral closure pressure and resistance.
自主咳嗽（VC）和喉呼气反射（LER）会引发压力性尿失禁（SUI）。本文旨在分析这些刺激对尿失禁发生时间的影响。
对123例有SUI病史的受试者进行了使用压力导管的尿动力学检测。通过诱导反射咳嗽试验（iRCT）触发LER。每位受试者接受VC和LER测试，并在一种或两种刺激下出现漏尿。记录漏尿的发生情况和时间。
与VC相比，LER时的峰值和平均腹内压高16 - 19%。123例受试者中，LER导致118例（96%）漏尿，VC导致71例（58%）漏尿，两种刺激均导致漏尿的有66例（54%）。与VC相比，LER导致的漏尿更可能发生在第一次呼气努力期间或之后立即发生。VC和LER的肌电图相似。
iRCT能可靠地引发LER，且比VC更有效地触发SUI。在VC过程中，尿道内括约肌（IUS）的平滑肌在吸气时开始收缩，IUS的收缩持续到呼气阶段；这种增加的尿道张力会降低SUI的可能性。我们将此称为吸气关闭反射（ICR）。对于LER，不会发生吸气，第一次呼气努力将作用于未收缩的IUS，使漏尿更有可能发生。我们的研究结果反驳了压力传递理论。尿道内括约肌和外括约肌可能都会增加尿道闭合压力和阻力。
