Nichols D H
Clin Obstet Gynecol. 1978 Sep;21(3):759-74. doi: 10.1097/00003081-197809000-00012.
It is evident that the maintenance and reestablishment of urinary continence is in large part dependent, during times of intraabdominal stress, upon maintenance of an intraurethral pressure higher than that within the bladder. It is important that the presence of cystocele be carefully and accurately assessed preoperatively and intraoperatively so that correction appropriate to its etiologic circumstance can be achieved. Continence is under the influence of urethral tone, as well as the response of the distal urethra to changes in intraabdominal pressure. Cranial elevation of the vesicourethral junction, as may be required, may be provided by any one of several different or combined surgical techniques. When vaginal inversion causes displacement of the vesicourethral junction, a restoration of vaginal depth and axis by transvaginal sacrospinous fixation with appropriate colporrhaphy will relocate a defective urethrovesical site to a higher level within the pelvis where it may once again be responsive to changes in intraabdominal pressure.
很明显，在腹内压增加时，尿失禁的维持和恢复在很大程度上取决于尿道内压力高于膀胱内压力。术前和术中仔细准确地评估膀胱膨出的存在非常重要，以便根据其病因情况进行适当的矫正。尿失禁受尿道张力以及尿道远端对腹内压变化反应的影响。必要时，膀胱尿道连接部的头侧抬高可通过几种不同或联合的手术技术中的任何一种来实现。当阴道内翻导致膀胱尿道连接部移位时，通过经阴道骶棘肌固定并进行适当的阴道壁修补术来恢复阴道深度和轴线，将使有缺陷的尿道膀胱部位重新定位到骨盆内更高的水平，在那里它可能再次对腹内压变化产生反应。
