藻酸钙凝胶治疗压力性尿失禁大鼠的漏尿点压力变化

目的：通过注射藻酸钙凝胶至压力性尿失禁（stress urinary incontinence,SUI）,观察大鼠近端尿道尿动力学变化,为其治疗压力性尿失禁的提供实验依据。方法：采用横断双侧阴部神经及盆底神经肌支建立压力性尿失禁的大鼠模型。雌性SD大鼠28只,分为4组：N组为正常对照组;C组为假手术组,暴露双侧阴部神经及盆底神经肌支但不切断;H组为对照组,切断双侧阴部神经及盆底神经肌支;M组为实验组,切断双侧阴部神经及盆底神经肌支,并在切断后2周注射藻酸钙凝胶20μL于大鼠尿道移行部黏膜下肌层。注射后1周,检测各组鼠漏尿点压力（leak point pressue,LPP）,注射后4周和8周,H组、M组鼠增加检测各1次。结果：N组、C组、H组、M组鼠1周后LPP分别为（46．00±4．02）cmH2O、（47．00±4．50）cmH2O、（30．67±6．24）cmH2O和（36．20±8．47）cmH2O;H组漏尿点压力明显低于N组、C组、M组（P〈0．05）。H组与M组在1、4、8周的LPP均有显著差异（P〈0．05）。M组鼠4、8周尿道横截面HE染色均见凝胶注射区域,体积无显著差异。结论：藻酸钙凝胶注射鼠近端尿道后能提高LPP,并在一定时间内维持稳定,其可能成为治疗压力性尿失禁的有效方法。     

聚丙烯阴道无张力悬吊带对压力性尿失禁大鼠模型膀胱和尿道结构及功能的长期影响

目的:观察应用人工材料由内向外经闭孔阴道无张力吊带 (transobturator tension-free vaginal tape, TVT-O)治疗雌性大鼠压力性尿失禁模型的长期疗效,以及聚丙烯吊带对膀胱尿道结构功能的影响.方法:实验于2006-06/2007-06在华北煤炭医学院动物中心实验室完成.选取青春期雌性SD大鼠24只,随机分为4组:①对照组只游离阴部神经,但不切断.②压力性尿失禁组、假手术组和TVT-O组行双侧阴部神经切断术建立压力性尿失禁模型.然后假手术组按TVT-O术操作,但不置入吊带;TVT-O组行标准的TVT-O术.于术后6周行腹压漏尿点压测定和膀胱测压.结果:23只大鼠进入结果分析.①腹压漏尿点压:压力性尿失禁组低于对照组(P = 0.028),TVT-O组恢复到对照组水平(P = 0.686).②最大逼尿肌收缩压:各组比较差异无显著性意义(P > 0.05).③膀胱容量:TVT-O组高于对照组和压力性尿失禁组(P < 0.05).④膀胱顺应性:TVT-O组高于压力性尿失禁组(P < 0.05).结论:①应用人工合成材料聚丙烯吊带行TVT-O治疗大鼠压力性尿失禁安全、长期有效,不影响膀胱的收缩功能,但可以使膀胱容量和顺应性增加.②双侧阴部神经切断术可以建立长期稳定的压力性尿失禁大鼠模型.     

聚丙烯阴道无张力悬吊带对压力性尿失禁大鼠模型膀胱和尿道结构及功能的长期影响

目的：观察应用人工材料由内向外经闭孔阴道无张力吊带（transobturator tension-free vaginal tape，TVT-O）治疗雌性大鼠压力性尿失禁模型的长期疗效，以及聚丙烯吊带对膀胱尿道结构功能的影响。方法：实验于2006-06/2007-06在华北煤炭医学院动物中心实验室完成。选取青春期雌性SD大鼠24只，随机分为4组：①对照组只游离阴部神经，但不切断。②压力性尿失禁组、假手术组和TVT-O组行双侧阴部神经切断术建立压力性尿失禁模型。然后假手术组按TVT-O术操作，但不置入吊带：TVT-O组行标准的TVT-O术。于术后6周行腹压漏尿点压测定和膀胱测压。结果：23只大鼠进入结果分析。①腹压漏尿点压：压力性尿失禁组低于对照组（P=0．028），TVT-O组恢复到对照组水平（P=0．686）。②最大逼尿肌收缩压：各组比较差异无显著性意义（P〉0．05）。③膀胱容晕：TVT-O组高于对照组和压力性尿失禁组（P〈0．05）。④膀胱顺应性：TVT-O组高于压力性尿失禁组（P〈0．05）。结论：①应用人工合成材料聚丙烯吊带行TVT-O治疗火鼠压力性尿失禁安全、长期有效，不影响膀胱的收缩功能，但可以使膀胱容量和顺应性增加。②双侧阴部神经切断术可以建立长期稳定的压力性尿失禁大鼠模型。     

自体脂肪源性干细胞与成纤维细胞联合尿道周围注射治疗大鼠压力性尿失禁

背景：干细胞增殖和分化形成成纤维细胞以及适当的结缔组织,从而实现组织的再生,治疗自体盆腔器官脱垂和压力性尿失禁是目前该领域的一个研究热点。目的：观察自体脂肪源性干细胞与成纤维细胞治疗压力性尿失禁的可行性。方法：建立压力性尿失禁大鼠模型,建模后1个月行自体脂肪源干细胞与成纤维细胞尿道周围注射,细胞移植后1个月测定大鼠腹压漏尿点压力,同时近端尿道组织采用苏木精-伊红染色、弹力纤维染色观察形态学改变。结果与结论：干细胞治疗后的模型大鼠漏尿点压力升高（P〈0.01）,膀胱排空正常。尿道壁肌层增厚（P〈0.01）,弹力纤维、平滑肌含量增多（P〈0.01）。结果证实,自体脂肪源性干细胞与成纤维细胞联合尿道周围注射能明显提高压力性尿失禁大鼠腹压漏尿点压力,增强注射点尿道肌层压力,可用于压力性尿失禁的治疗。     

压力性尿失禁动物模型建立

目的探讨模拟产伤建立压力性尿失禁动物模型的可行性。方法雌性成年未育SD大鼠22只,分为实验组15只,对照组7只。实验组行阴道损伤即模拟产伤,对照组仅插入阴道扩张气囊和导尿管,常规饲养1个月后行尿动力学检查。结果术后2组最大膀胱容积、漏尿点压力、腹压漏尿点压、喷嚏试验差异均有统计学意义(P<0.05)。结论模拟产伤可有效建立雌性大鼠压力性尿失禁模型。     

电针刺激三阴交穴对压力性尿失禁大鼠脊髓NMDA受体及α2受体表达的影响

目的观察电针刺激三阴交穴对压力性尿失禁(SUI)大鼠控尿能力及脊髓N-甲基-D-天冬氨酸(NMDA)受体、α2肾上腺素能受体表达的影响。方法采用随机数字表法将48只成年雌性SD大鼠分为3组,其中假手术组大鼠阴道内置入未注水球囊尿管,模型组大鼠行阴道内球囊扩张制作SUI模型,电针组大鼠待阴道内球囊扩张建模成功后,对其三阴交穴给予电针刺激。经1周干预后,3组大鼠均进行尿流动力学检查及腹压漏尿点压(LPP)测定,并同步进行尿道外括约肌肌电描记。另外本研究还分别采用PCR及Western blot方法比较各组大鼠脊髓L₆-S₁节段NMDA受体及α2受体表达变化。结果3组大鼠各项尿流动力学指标组间差异均无统计学意义(P>0.05)。与假手术组比较,模型组大鼠腹压LPP、尿道外括约肌肌电频率及振幅均显著降低(P<0.05)。与模型组比较,电针组大鼠腹压LPP显著提高(P<0.05),尿道外括约肌肌电频率及振幅均显著增加(P<0.05)。与模型组比较,电针组大鼠L₆-S₁脊髓节段NMDA、α₂受体mRNA及蛋白表达均明显上调(P<0.05)。结论阴道球囊扩张是制作SUI大鼠模型的有效方法;电针刺激三阴交穴在改善SUI模型大鼠控尿能力同时,还不会影响大鼠正常排尿功能,其治疗机制可能与上调脊髓中NMDA及α2受体水平、增强尿道外括约肌活性有关。     

应力性漏尿点压测定在女性真性压力性尿失禁诊断中的应用

背景尿失禁包括压力性、急迫性以及二者混合型,临床上凭经验很难准确判断其类型和程度,常发生误诊误治.目的为探讨尿动力学检查,尤其是应力性漏尿点压测定对女性压力性尿失禁的诊断价值.设计回顾性平行对照观察.单位解放军第三军医大学西南医院全军泌尿专科中心.对象选择1996-01/2002-05来第三军医大学西南医院泌尿外科就诊的尿失禁女性患者120例.方法①膀胱尿道造影测定患者膀胱尿道后角＜100°判定为正常,＞100°判定为异常.尿道倾斜角＜45°判定为正常,＞45°判定为异常.膀胱尿道连接部(静态时)无下降判定为正常,下降0.5 cm判定为异常.②尿动力学检查检查项目依次为充盈性膀胱测压,静态尿道压力图测定、漏尿点压测定.③分型标准膀胱尿道造影分型标准Ⅰ型膀胱尿道后角消失,尿道倾斜角＜45°,最大尿道关闭压＞20 cmH2O;Ⅱ型膀胱尿道后角消失,尿道倾斜角＞45°,最大尿道关闭压＞20 cmH2O;Ⅲ型膀胱尿道后角正常,尿道倾斜角＜45°,最大尿道关闭压＜20 cmH2O.应力性漏尿点压分型标准Ⅰ型应力性漏尿点压＞120 cmH2O;Ⅱ型应力性漏尿点压90～120 cmH2O;Ⅲ型应力性漏尿点压＜60 cmH2O;Ⅱ/Ⅲ型应力性漏尿点压60～90 cmH2O.主要观察指标①尿失禁患者尿动力学检查结果.②应力性漏尿点压分型结果及其与膀胱尿道造影分型结果的比较.结果120例患者均进入结果分析.①尿动力学检查结果经检查确诊为真性压力性尿失禁患者56例,症状性压力性尿失禁患者64例,其中不稳定膀胱28例,低顺应性膀胱36例.②应力性漏尿点压分型与膀胱尿道造影分型结果比较56例真性压力性尿失禁患者中Ⅰ型20例;Ⅱ型16例;Ⅱ/Ⅲ型10例;Ⅲ型10例.两种分型在Ⅰ和Ⅲ型上吻合率达到100%,Ⅱ和Ⅱ/Ⅲ型的吻合率分别达到94.1%和90.1%,无显著差异(P＞0.05)结论应力性漏尿点压测定能够对女性真性压力性尿失禁进行准确的的分型,并对其治疗有着重要的指导作用.     

盆底肌锻炼治疗女性尿失禁

背景：女性尿失禁分为压力性、急迫性、混合性等多种类型。正常贮尿和排尿功能依赖于下尿道、盆底与神经系统结构与功能的完整。以耻尾骨、肛提肌为主的盆底肌对膀胱、尿道、阴道、直肠起支持作用，在维持控尿方面起重要作用。当膀胱逼尿肌和尿道括约肌的收缩与松弛失调，或当阴道及盆底支撑组织结构破坏或减弱时，均可发生尿失禁。     

超声尿动力学对尿道最大关闭压和腹压漏尿点压及膀胱颈移动度的研究

目的应用超声尿动力学技术研究静态和动态尿道关闭压及膀胱颈移动度的关系。方法对40例真性压力性尿失禁和22例正常入进行超声和尿动力学同步观察,标化测定静态最大尿道关闭压、腹压漏尿点压和膀胱颈移动度。结果真性压力性尿失禁腹压漏尿点压与尿道最大关闭压呈明显的线性相关(r=0.49,P=0.001),其回归方程y=21.90+0.88x。压力性尿失禁尿道最大关闭压、腹压漏尿点压均值显著低于正常组(P＜0.01)。膀胱颈部移动度显著高于正常组(P＜0.01)。腹压漏尿点压＞55cmH     

应力性漏尿点压测定在女性真性压力性尿失禁诊断中的应用

背景：尿失禁包括压力性、急迫性以及二者混合型，临床上凭经验很难准确判断其类型和程度，常发生误诊误治。目的：为探讨尿动力学检查，尤其是应力性漏尿点压测定对女性压力性尿失禁的诊断价值。设计：回顾性平行对照观察。单位：解放军第三军医大学西南医院全军泌尿专科中心。对象：选择1996-01／2002-05来第三军医大学西南医院泌尿外科就诊的尿失禁女性患者120例。方法：①膀胱尿道造影：测定患者膀胱尿道后角：〈100&;#176;判定为正常，〉100&;#176;判定为异常。尿道倾斜角：〈45&;#176;判定为正常，〉45&;#176;判定为异常。膀胱尿道连接部（静态时）：无下降判定为正常，下降0.5cm判定为异常。②尿动力学检查：检查项目依次为充盈性膀胱测压，静态尿道压力图测定、漏尿点压测定。③分型标准：膀胱尿道造影分型标准：Ⅰ型：膀胱尿道后角消失，尿道倾斜角〈45&;#176;，最大尿道关闭压〉20cmH2O；Ⅱ型：膀胱尿道后角消失，尿道倾斜角〉45&;#176;，最大尿道关闭压〉20cmH2O；Ⅲ型：膀胱尿道后角正常，尿道倾斜角〈45&;#176;，最大尿道关闭压〈20cmH2O。应力性漏尿点压分型标准：Ⅰ型：应力性漏尿点压〉120cmH2O；Ⅱ型：应力性漏尿点压90～120cmH2O；Ⅲ型：应力性漏尿点压〈60cmH20；Ⅱ／Ⅲ型：应力性漏尿点压60-90cmH2O。主要观察指标：①尿失禁患者尿动力学检查结果。②应力性漏尿点压分型结果及其与膀胱尿道造影分型结果的比较。结果：120例患者均进入结果分析。①尿动力学检查结果：经检查确诊为真性压力性尿失禁患者56例，症状性压力性尿失禁患者64例．其中不稳定膀胱28例，低顺应性膀胱36例。②应力性漏尿点压分型与膀胱尿道造影分型结果比较：56例真性压力性尿失禁患者中Ⅰ型20例；Ⅱ型16例；Ⅱ／Ⅲ型10例；Ⅲ型10例。两种分型在Ⅰ和Ⅲ型上吻合率达到100％，Ⅱ和Ⅱ／Ⅲ型的吻合率分别达到94.1％和90.1％，无显著差异（P〉0．05）。结论：应力性漏尿点压测定能够对女性真性压力性尿失禁进行准确的的分型，并对其治疗有着重要的指导作用。     

Short-term timecourse of bilateral pudendal nerve injury on leak-point pressure in female rats

The pudendal nerve innervates the external urethral sphincter and, when injured, can contribute to incontinence development. This experiment was designed to study the time course of functional changes in the urethra after pudendal nerve crush in rats. Leak-point pressure (LPP) was measured 2, 4, 7, or 14 days after bilateral pudendal nerve crush and was compared to that of a control group. LPP at all four time points after nerve injury was significantly decreased compared to control values. A minimum was reached 4 days after injury, and LPP appeared to trend upward with increasing time after injury, suggesting that nerve function may begin to recover or compensatory changes in the urethra may occur. Pudendal nerve crush induces decreased LPP in female rats, mimicking the clinical symptoms of stress incontinence. When fully characterized, this model could be useful for preclinical testing of treatment and rehabilitation protocols.     

Perineal neuromuscular fatigue.

AIM: The physiology of urinary continence during stress is complex and the role of passive and active mechanisms remains unclear. Coughing leads to a contraction of urethral rhabdomyosphincter and pelvic floor muscles leading to a positive urethro-vesical gradient and continence. Neuromuscular fatigue can involve all striated muscles, including rhabdomyosphincter, peri-urethral and pelvic floor muscles. This article reviews results of studies assessing perineal muscular fatigue in urinary incontinence. MATERIALS AND METHODS: A systematic review of the literature (Medline, Pascal and Embase) with use of the MESH keywords fatigue, stress, urinary incontinence, pelvic floor, urethra, urethral pressure, and muscle. RESULTS: Animal models have shown that the pelvic muscles (iliococcygeus and pubococcygeous) exhibit more neuromuscular fatigue than classical skeletal striated muscles (i.e. soleus muscle). Although the human external urethral sphincter is considered to be a highly fatigue-resistant muscle with its high proportion of slow muscle fibers, repeated coughing seems to lead to decreased urethral pressure in numerous women affected with stress urinary incontinence. In this case, "urethral fatigue" might be a possibility. CONCLUSIONS: Although few studies have focused on perineal muscular fatigue, such increased fatigue in pelvic floor muscles may play a role in the pathophysiologic features of stress urinary incontinence in women.     

Effect of abdominal versus pelvic floor muscle exercises in obese Egyptian women with mild stress urinary incontinence: A randomised controlled trial

The aim of this study was to compare the benefits of a 12-week abdominal and pelvic floor muscle strength training programme for the treatment of mild stress urinary incontinence (SUI) in obese women. Thirty obese female patients with mild SUI were randomly divided into two groups: the abdominal exercise (ABD) group and the pelvic floor exercise (PF) group. The participants were evaluated for vaginal pressure, leak point pressure (LPP) and waist–hip ratio (WHR) before, immediately after and at a 12-week follow-up after the termination of treatment. The ABD group showed a significant increase in vaginal pressure immediately after the intervention and at follow-up (p < 0.001), while the PF group showed no significant change in this variable. The ABD group also showed a significant increase in LPP after 12 weeks of treatment (p = 0.008), while the PF group demonstrated no significant change in the same variable (p = 0.030). At 24 weeks, the LPP remained significantly different from the baseline only for the ABD group (p = 0.005). The results showed that the 12-week abdominal muscle strength training programme is superior to pelvic floor strength training for the treatment of mild SUI in obese patients.     

Stooling problems in patients with myelomeningocele.

In children with myelomeningocele fecal and urinary incontinence lowers self-esteem and decreases social interaction. The defects in the lumbosacral spine disturb the sensory and motor nerves supplying the skin and muscles of the perianal region, including the puborectalis muscle, and the external anal sphincter. The sensations in the region, as well as the motor functions of the striated muscles suffer, compromising the dynamics of continence and the normal process of stooling and leading to incontinence and constipation. Constipation has been treated by disimpaction of stools from the colon and rectum, administration of stool softeners, and a healthy diet containing adequate bulk-forming items. Incontinence has usually been managed by behavior modification of self-initiating stooling after meals and positive reinforcement of this process. This method has helped up to 75% of patients to become socially continent. Biofeedback training has been helpful in patients who have preservation of some sensorimotor functions in the perianal region and who understand and cooperate in the process of biofeedback training. The enema continence catheter has been used to empty the rectosigmoid every 48 hours; most children treated in this manner have achieved social continence. Electric stimulation of the pudendal nerves using a neuroprosthetic device has been used in some patients. The pudendal nerve is stimulated continuously to achieve continence; stimulation is discontinued only for stooling and/or urination.     

Effects of inner muscle resistance exercise on stress urinary incontinence: a randomized clinical controlled trial

[Purpose] This study investigated the effects of co-contraction resistance exercises of the transverse abdominal and pelvic floor muscles in middle-aged females with stress urinary incontinence. [Participants and Methods] We included 32 females with stress urinary incontinence and divided them into two groups: the inner muscle training group and the pelvic floor muscle group. The thickness of the transverse abdominal muscle was measured during four tasks: (1) rest, (2) maximum contraction of the transverse abdominal muscle, (3) maximum contraction of the pelvic floor muscle, and (4) maximum co-contraction of the transverse abdominal and pelvic floor muscles. In the latter three tasks, measurements were obtained while the participants performed resistance movements using a Thera-band^®. A home program was conducted in both groups, and the intervention lasted for 8 weeks. [Results] The cure rates for SUI were 87.5% and 68.8% in the inner muscle training and pelvic floor muscle groups, respectively. After the intervention, the thickness of the transverse abdominal muscle significantly increased in the inner muscle training groups performing maximum co-contraction of the transverse abdominal and pelvic floor muscles and maximum contraction of the transverse abdominal muscle. [Conclusion] Inner muscle training exercises are more effective than pelvic floor muscle exercises in improving inner muscle function and urinary incontinence in middle-aged females.     

女性盆底肌锻炼的超声尿动力学实时观察

目的：应用超声尿动力学对女性压力性尿失禁盆底肌锻炼进行监测。方法：对30例压力性尿失禁患者盆底肌收缩与松弛动作进行观察，对照组为20例正常妇女。比较两组下尿路形态与盆底功能参数的差异。结果：盆底肌收缩较之松驰时，膀胱尿道连接部向前向上运动，尿道轴向上向前旋转，尿道最大关闭压、阴道压明显提高。病例组盆底肌收缩力度明显低于正常组。结论：超声尿动力学方法可以实时反映盆底肌运动时下尿路的解剖与盆底功能的改变，有利于对压力性尿失禁盆底肌的锻炼进行监测。     

盆底肌电刺激在女性尿失禁治疗中的应用

目的 探讨盆底肌电刺激对女性尿失禁的作用机制及疗效。方法 对43例女性尿失禁患者应用盆底肌电刺激治疗，电极探头置于阴道中部，在不同的电流状态下，间歇刺激阴部神经。结果 尿失禁患者渗、漏尿事件减少46％，尿频次数减少49％，24h内排尿次数在10～12次之间；患者的总主观改善率为68％，总客观改善率为74％。结论 盆底肌电刺激对女性尿失禁有明显疗效，能提高患者生活质量。     

Rehabilitation of pelvic floor muscles utilizing trunk stabilization

The pelvic floor muscles (PFM) are part of the trunk stability mechanism. Their function is interdependent with other muscles of this system. They also contribute to continence, elimination, sexual arousal and intra-abdominal pressure. This paper outlines some aspects of function and dysfunction of the PFM complex and describes the contribution of other trunk muscles to these processes. Muscle pathophysiology of stress urinary incontinence (SUI) is described in detail. The innovative rehabilitation programme for SUI presented here utilizes abdominal muscle action to initiate tonic PFM activity. Abdominal muscle activity is then used in PFM strengthening, motor relearning for functional expiratory actions and finally impact training.