Kessler R, Constantinou C E
J Urol. 1986 Dec;136(6):1248-53. doi: 10.1016/s0022-5347(17)45303-1.
The cause of incontinence in a group of 11 girls (mean age 18 +/- 3 years) who had undergone internal urethrotomy during childhood was assessed. Urodynamic methods were used to characterize the detrusor, and urethral profiles were performed to identify the impact of the operation on the extrinsic and intrinsic mechanisms of urethral closure. The results show that 4 of 11 patients demonstrated detrusor instability associated with a high voiding flow rate. The average resting urethral closure pressure in all patients showed significant reduction in maximum closure pressure (62 +/- 32 cm. water) when compared to normal age-matched controls. Transmission pressures to coughing demonstrated a high percentage of transmission to the distal and mid urethra (180 +/- 20 per cent). It was concluded that the intrinsic mechanism of urethral continence as measured by the resting urethral pressure profile was compromised by the urethrotomy. However, the extrinsic mechanisms as measured by the transmission values was not affected. On the basis of these findings it is argued that internal urethrotomy compromises the closure mechanisms intrinsic to the urethra. Continence in these patients most likely is maintained by the action of extrinsic factors transmitting high closure pressures at the distal third of the urethra. Finally, it is postulated that urethrotomy patients are at increased risk for stress incontinence at an early age.
对一组童年期接受过尿道内切开术的11名女孩（平均年龄18±3岁）尿失禁的原因进行了评估。采用尿动力学方法来描述逼尿肌的特征，并进行尿道压力描记以确定手术对尿道闭合的外在和内在机制的影响。结果显示，11名患者中有4名表现出与高排尿流速相关的逼尿肌不稳定。与年龄匹配的正常对照组相比，所有患者静息尿道闭合压的最大闭合压均显著降低（62±32厘米水柱）。咳嗽时的传递压力显示，远端和中段尿道的传递比例很高（180±20%）。得出的结论是，通过静息尿道压力描记测得的尿道控尿内在机制因尿道切开术而受损。然而，通过传递值测得的外在机制未受影响。基于这些发现，有人认为尿道内切开术损害了尿道固有的闭合机制。这些患者的控尿很可能是由外在因素在尿道远端三分之一处传递高闭合压力的作用来维持的。最后，推测尿道切开术患者在早年发生压力性尿失禁的风险增加。
