Monga A K, Stanton S L
Urogynaecology Unit, St George's Hospital, London, UK.
Br J Obstet Gynaecol. 1997 Feb;104(2):158-62. doi: 10.1111/j.1471-0528.1997.tb11037.x.
To assess the role of urodynamics in the prediction and assessment of outcome and analysis of the mechanism of cure for stress incontinence using periurethral collagen as our treatment model.
Prospective longitudinal study.
A teaching hospital tertiary referral centre.
Sixty women with genuine stress incontinence.
The objective cure rate was 54% (n = 54) at 12 months. Subtracted cystometry, urethral electrical conductivity and bladder neck excursion measurements did not predict cure. A low pre-injection maximum urethral closure pressure adversely affects outcome (31 cmH2O (success) vs 19 cmH2O (failure), P = 0.004); all women with a maximum urethral closure pressure > 39 cmH2O were rendered dry. Urethral pressure profilometry can analyse mechanism of cure. Total profile length, stress maximum urethral closure pressure, stress functional urethral length and pressure transmission ratio in the first quarter of urethral length were increased in successful cases (P < 0.05), and rest maximum urethral and maximum urethral closure pressures, area under rest profile and pressure transmission ratio in the second quarter of urethral length were increased in failed cases (P < 0.02).
In successful cases the increased area and pressure transmission ratio in the first quarter of the functional urethral length suggest that collagen placement occurs at the bladder neck or proximal urethra. Cure appears to be due to prevention of bladder neck opening during stress and not obstruction. In addition the cephalad elongation of the urethra caused by collagen probably accounts for the increased abdominal pressure transmission in the first quarter of the urethra. In failures, there is an increased length and increased area to peak pressure suggesting collagen is deposited more distally. This study confirms the role of certain urethral pressure profilometry variables in the prediction and analysis of mechanism of cure.
以尿道周围注射胶原蛋白作为治疗模型，评估尿动力学在压力性尿失禁预后预测、评估及治愈机制分析中的作用。
前瞻性纵向研究。
一所教学医院的三级转诊中心。
60例真性压力性尿失禁女性。
12个月时客观治愈率为54%（n = 54）。减去膀胱测压、尿道电导率和膀胱颈移位测量结果不能预测治愈情况。注射前最大尿道闭合压较低对预后有不利影响（成功组为31 cmH₂O，失败组为19 cmH₂O，P = 0.004）；所有最大尿道闭合压> 39 cmH₂O的女性均实现了干爽。尿道压力描记法可分析治愈机制。成功病例中，尿道全长、应激时最大尿道闭合压、应激时功能性尿道长度以及尿道长度第一季度的压力传递率均增加（P < 0.05），而失败病例中，休息时最大尿道压和最大尿道闭合压、休息时压力曲线下面积以及尿道长度第二季度的压力传递率增加（P < 0.02）。
在成功病例中，功能性尿道长度第一季度面积和压力传递率增加表明胶原蛋白注射部位在膀胱颈或尿道近端。治愈似乎是由于在应激时防止膀胱颈开放而非梗阻。此外，胶原蛋白导致的尿道向头侧延长可能是尿道第一季度腹压传递增加的原因。在失败病例中，压力峰值处长度和面积增加表明胶原蛋白沉积位置更靠远端。本研究证实了某些尿道压力描记法变量在预后预测和治愈机制分析中的作用。
