Kim K J, Ashton-Miller J A, Strohbehn K, DeLancey J O, Schultz A B
Department of Mechanical Engineering and Applied Mechanics, University of Michigan, Ann Arbor 48109-2125, USA.
J Biomech. 1997 Jan;30(1):19-25. doi: 10.1016/s0021-9290(97)81291-2.
About one-third of older multiparous women are prone to stress urinary incontinence (SUI): unwanted urine loss during activities which suddenly raise intra-abdominal pressure. In this paper we describe and test a method for visualizing and analyzing the function of the urinary continence control system (CCS) under stress. Intravesical and intraurethral pressure changes from the resting state were recorded at proximal, mid-, and distal urethral locations during increasingly severe coughs and cross-plotted on a 'vesico-urethral pressuregram.' The slope (alpha) and intercept (chi zero) resulting from a linear regression analysis of these data were used to develop a continence equation which can be used to predict the equilibrium point pressure (PE): the intravesical pressure at which urine will leak to the intraurethral pressure recording site. We tested the null hypothesis that these parameters would not differ in six young, nulliparous continent women (mean +/- S.D. age: 30 +/- 3.5 yr) and six multiparous SUI women (52.3 +/- 8.0 yr, parity: 1.7 +/- 0.8), or between urethral locations. Significant differences in continence equation parameters were found between groups and in different urethral locations. In the SUI group static factors calculated from the term (1 - alpha) contributed 27% of the mean (S.D.) midurethral PE value, 145 (46) cm H2O, while dynamic factors, estimated from alpha, contributed 73% of this value. Valuable insights for improving the diagnosis and treatment of SUI may be obtained by analyzing the relative contributions of alpha and chi 0 to urethral closure during physical stress.
约三分之一的经产妇易患压力性尿失禁（SUI），即在突然增加腹内压的活动中出现不自主的尿液流失。在本文中，我们描述并测试了一种在压力状态下可视化和分析控尿系统（CCS）功能的方法。在逐渐加重的咳嗽过程中，记录膀胱内和尿道内压力从静息状态开始在尿道近端、中段和远端位置的变化，并交叉绘制在“膀胱尿道压力图”上。对这些数据进行线性回归分析得到的斜率（α）和截距（χ0）用于建立一个控尿方程，该方程可用于预测平衡点压力（PE），即尿液将漏至尿道内压力记录部位时的膀胱内压力。我们检验了以下无效假设：在6名年轻未生育的控尿女性（平均±标准差年龄：30±3.5岁）和6名经产压力性尿失禁女性（52.3±8.0岁，产次：1.7±0.8）之间，或在尿道不同位置之间，这些参数不会有差异。结果发现，控尿方程参数在不同组之间以及尿道不同位置存在显著差异。在压力性尿失禁组中，由（1 - α）项计算得出的静态因素对平均（标准差）尿道中段PE值145（46）cm H2O的贡献为27%，而由α估计得出的动态因素对该值的贡献为73%。通过分析α和χ0在身体应激期间对尿道闭合的相对贡献，可能会获得对改善压力性尿失禁诊断和治疗有价值的见解。
