Payne C K
Center for Female Urology and NeuroUrology, Stanford University Medical Center, California 94305-5118, USA.
Urology. 1998 Feb;51(2A Suppl):3-10. doi: 10.1016/s0090-4295(98)90001-2.
To present an overview of current knowledge regarding the epidemiology, pathophysiology, and evaluation of urinary incontinence (UI) with a focus on the problem of the overactive bladder.
The most recent data on the epidemiology of UI are presented. The literature on the pathophysiology of urinary urge incontinence (UUI) is reviewed, and key concepts related to patient evaluation are summarized.
The prevalence of UI depends on the population being surveyed. The overactive bladder constitutes a substantial percentage of the overall problem, ranging from > 50% of incontinent men to only 10% to 15% of incontinent younger women. Few data are available on the incidence of the disorder or on racial/ethnic trends. Overactive bladder or urge incontinence is called detrusor hyperreflexia when a neurologic cause is known and detrusor instability when there is no neurologic abnormality. Although the pathophysiology of idiopathic instability is not well understood, some evidence suggests that this condition may result from subclinical neurologic disease or primary smooth muscle disease. Most patients with UUI can be adequately evaluated with a history, physical examination, determination of postvoid residual volume, and urinalysis. When neurologic disease or other complicating factors are present, or if initial treatment fails, sophisticated urodynamic testing is appropriate.
Urinary incontinence is prevalent in all strata of the population, although it affects women and the elderly disproportionately. With the exception of cases in which a neurologic lesion can be demonstrated, the etiology of UUI remains elusive. A thorough history, physical examination, determination of postvoid residual, and urinalysis will be adequate to classify and treat the majority of patients.
概述目前有关尿失禁（UI）的流行病学、病理生理学及评估方面的知识，重点关注膀胱过度活动症问题。
介绍了尿失禁最新的流行病学数据。回顾了有关急迫性尿失禁（UUI）病理生理学的文献，并总结了与患者评估相关的关键概念。
尿失禁的患病率取决于所调查的人群。膀胱过度活动症在整个尿失禁问题中占相当大的比例，从超过50%的尿失禁男性到仅10%至15%的年轻尿失禁女性。关于该疾病的发病率或种族/民族趋势的数据很少。当已知神经学病因时，膀胱过度活动症或急迫性尿失禁称为逼尿肌反射亢进；当不存在神经学异常时，则称为逼尿肌不稳定。尽管特发性不稳定的病理生理学尚未完全了解，但一些证据表明，这种情况可能是由亚临床神经疾病或原发性平滑肌疾病引起的。大多数UUI患者通过病史、体格检查、测定排尿后残余尿量和尿液分析即可得到充分评估。当存在神经疾病或其他复杂因素，或初始治疗失败时，进行复杂的尿动力学检查是合适的。
尿失禁在所有人群阶层中都很普遍，尽管它对女性和老年人的影响尤为严重。除了能证明存在神经病变的病例外，UUI的病因仍然不明。全面的病史、体格检查、测定排尿后残余尿量和尿液分析足以对大多数患者进行分类和治疗。
