Thom D H, Brown J S
Stanford University, Palo Alto, California, USA.
J Am Geriatr Soc. 1998 Nov;46(11):1411-7. doi: 10.1111/j.1532-5415.1998.tb06009.x.
To review and integrate the current literature on the role of reproductive factors in the development of urinary incontinence in later life.
An extensive literature review using Medline and Science Citation Index for the period 1966 through 1997 was undertaken to identify published studies of the association between parturition events, hysterectomy, menopause, estrogen therapy, and later urinary incontinence.
Vaginal delivery is an established risk factor for both transient postpartum incontinence and the development of incontinence in later life. Several studies have found evidence of nerve and muscle damage that provide a physiologic basis for this association. Prospective studies of incontinence after hysterectomy have generally found no increased risk in the first few years. In contrast, cross-sectional epidemiologic studies have consistently found an increased risk many years after hysterectomy. Although menopause is often considered a risk factor for urinary incontinence, epidemiological studies have generally not found an increase in the prevalence of incontinence in the perimenopausal period. Oral estrogen replacement therapy seems to have little short-term clinical benefit in regard to incontinence and is associated consistently with increased risk of incontinence in women aged 60 years and older in epidemiologic studies.
This review provides a framework for further investigation of the complex relationships between reproductive risk factors and urinary incontinence. Integration of physiologic, clinical, and epidemiologic studies is needed to address the compelling health care issue of urinary incontinence. Suggestions are made for further areas of research.
回顾并整合当前关于生殖因素在晚年尿失禁发生中作用的文献。
利用1966年至1997年期间的Medline和科学引文索引进行广泛的文献回顾，以确定已发表的关于分娩事件、子宫切除术、绝经、雌激素治疗与晚年尿失禁之间关联的研究。
阴道分娩是产后短暂性尿失禁和晚年发生尿失禁的既定危险因素。多项研究发现了神经和肌肉损伤的证据，为这种关联提供了生理基础。子宫切除术后尿失禁的前瞻性研究通常在最初几年未发现风险增加。相比之下，横断面流行病学研究一致发现子宫切除术后多年风险增加。虽然绝经通常被认为是尿失禁的危险因素，但流行病学研究一般未发现围绝经期尿失禁患病率增加。在尿失禁方面，口服雌激素替代疗法短期似乎几乎没有临床益处，并且在流行病学研究中，60岁及以上女性中与尿失禁风险增加始终相关。
本综述为进一步研究生殖危险因素与尿失禁之间的复杂关系提供了框架。需要整合生理、临床和流行病学研究来解决引人关注的尿失禁医疗保健问题。提出了进一步研究领域的建议。
