干细胞治疗女性压力性尿失禁的临床进展

压力性尿失禁在各年龄段妇女普遍存在,严重影响女性生活质量及社会形象,现行的治疗手段效果不理想.对压力性尿失禁发病机制的探索,已认识到中段尿道及尿道外括约肌是尿控关键.近年,自体干细胞移植作为新的治疗手段,对女性压力性尿失禁的治疗获得可喜成果.综述干细胞治疗女性压力性尿失禁的近况.     

压力性尿失禁问卷评分对女性压力性尿失禁诊断的价值

目的:探讨压力性尿失禁问卷评分(SS)对女性压力性尿失禁(SUI)的诊断价值。方法:对我院妇科确诊为压力性尿失禁的44例患者进行压力性尿失禁问卷评分,分析1小时尿垫实验(1HPTV)与SS之间的相关性。结果:1HPTV与SS之间有相关性;Lg[1HPTV]与SS之间有非常明显相关性。SS评分对于中度SUI诊断的敏感性为70.0%,特异性为76.5%;对于诊断重度SUI患者,SS评分诊断的敏感性为75.0%,特异性为91.7%。身高、体重、年龄和Lg[1HPTV]是影响SS的主要因素。结论:SS是协助临床诊断女性压力性尿失禁的简捷、经济、无创、准确的一种新方法。     

Stem Cell Therapy for Female Urinary Incontinence

Both stress and urge urinary incontinence affect a significant proportion of women, yet the treatment options currently available may lack long-term effectiveness or may be associated with significant adverse events limiting their use. Thus, novel treatment options are needed. Stem cells, with the ability to transform into multiple cell types or to self-renew, have been proposed as a potential treatment option for both stress and urge incontinence. The majority of research has been performed in animal models and has shown that urethral or intradetrusor injection of various types of stem cells improves surrogate markers of incontinence. Although many of these studies have shown promising effects, significant research is still needed before translating these findings into clinical practice.     

Urinary Stress Incontinence and Common Sense

Retropubic bladder neck suspension has been used to treat 352 women presenting with the primary complaint of urinary stress incontinence. The author's concept of the proper assessment and management of such patients, in whom previous surgical treatment has failed, is stated. A plea is made for the abandonment of traumatic surgical methods and the confusing multiplicity of names that accompanies them.     

Nonsurgical Transurethral Collagen Denaturation for Stress Urinary Incontinence in Women: 12-Month Results from a Prospective Long-term Study

Study ObjectiveTo assess efficacy of nonsurgical transurethral collagen denaturation (Renessa) in women with stress urinary incontinence (SUI) caused by bladder outlet hypermobility.DesignContinuing, prospective, 36-month, open-label, single-arm clinical trial. Twelve-month results from intent-to-treat (ITT) analysis are reported. Canadian Task Force classification II-2.SettingThirteen physician offices or ambulatory treatment centers.PatientsWomen with SUI secondary to bladder outlet hypermobility for 12 months or longer who failed earlier conservative treatment and had not received earlier surgical or bulking agent therapy.InterventionsWomen were treated as outpatients and received an oral antibiotic and local periurethral anesthesia before undergoing treatment with transurethral radiofrequency collagen denaturation.Measurements and Main ResultsVoiding diaries and in-office stress pad weight tests yield objective assessments. Subjective measures include the Incontinence Quality of Life (I-QOL), Urogenital Distress Inventory (UDI-6), and Patient Global Impression of Improvement (PGI-I) instruments. In total, 136 women received treatment (ITT population). Patients experienced significant reductions versus baseline in median number of leaks caused by activity/day and activity/week (p <.0026 for both), with 50% of patients reporting 50% or more reduction. Pad weight tests revealed that 69% of women had 50% or more reduction in leakage (median reduction 15.2 g; p <.0001); 45% were dry (29% no leaks; 16% < 1-g leakage). Significant improvements occurred in median scores on the I-QOL (+9.5 [range –66.0 to 91.0]; p <.0001) and mean scores on the UDI-6 (–14.1 ± 24.7; p <.0001). Furthermore, 71.2% showed I-QOL score improvement, including 50.3% with 10-point or greater improvement, and 49.6% reported on the PGI-I that they were “a little,” “much,” or “very much” better.ConclusionAt 12 months, treatment of SUI with nonsurgical transurethral collagen denaturation resulted in significant improvements in activity-related leaks and quality of life.     

Sexual Function Following Treatment for Stress Urinary Incontinence With Bulk Injection Therapy and Mid-Urethral Sling Surgery

BackgroundPeri-urethral bulking injections (PBI) gain popularity for the treatment of stress urinary incontinence (SUI), but – in contrast to mid-urethral sling (MUS) surgery – little is known about its impact on sexual function.MethodsThis was a secondary analysis of a prospective cohort study that included patients with moderate to severe SUI undergoing either MUS surgery or PBI with polydimethylsiloxane Urolastic (PDMS-U). The validated Dutch and English version of the ‘Pelvic Organ Prolapse and/or Urinary Incontinence Sexual Function Questionnaire – IUGA Revised’ (PISQ-IR) was used to assess sexual function at baseline, at 6 and 12 months of follow-up. For between-group analysis, differences in baseline characteristics were corrected using multivariate analysis of covariance.OutcomesThe primary outcome was the PISQ-IR single summary score of sexually active (SA) women following both procedures, calculated by mean calculation. Secondary outcomes were the PISQ-IR subscale scores of SA and non-sexually active (NSA) women, the proportions of sexual activity and subjective improvement (‘Patient Global Impression of Improvement’ (PGI-I)).ResultsA total of 259 women (MUS: n = 146, PBI: n = 113) were included in this study. The PISQ-IR single summary score of SA women improved following both interventions (in the MUS group from 3.2 to 3.4 and in the PBI group from 3.0 to 3.3 after 12 months). After correcting for differences in baseline characteristics, the PISQ-IR summary score at 6 and 12 months was similar for both treatment groups. For SA women, condition-specific and condition-impact subscale scores significantly improved following both procedures.Clinical implicationsIn treating SUI, PBI is inferior to MUS surgery. However, there is a need for less invasive strategies, especially for women who are unfit for surgery or have contraindications. Sexual function improves after PBI using PDMS-U, which is relevant for the counselling of women with SUI about available treatment options.Strengths & limitationsStrength: until this study, there was a lack of knowledge about the effects of PBI on sexual function. Limitation: there may be indication bias as we did not perform a randomized controlled trial.ConclusionPBI using PMDS-U and MUS surgery for the treatment of SUI improve sexual function equally in SA women, mainly by decreasing the condition's impact on sexual activity and quality.Latul YP, Casteleijn FM, Zwolsman SE, et al. Sexual Function Following Treatment for Stress Urinary Incontinence With Bulk Injection Therapy and Mid-Urethral Sling Surgery. J Sex Med 2022;19:1116–1123.     

Advances in Urogynaecology: The Nonsurgical Management of Genuine Stress Incontinence

Urinary incontinence in women is a common, debilitating and expensive condition. During this century, great strides, both surgical and nonsurgical, have been made in the management of urinary incontinence. While surgery will continue to be the mainstay of therapy for genuine stress incontinence, there are now many innovative and effective nonsurgical approaches to the treatment of this condition. External urethral plugs can be used to maintain continence for short periods of time. New adjuncts to enhance pelvic muscle exercise programmes include functional electrical stimulation devices and weighted vaginal cones, with cure or improvement in incontinence seen in between 70 and 80 percent of patients. Several types of intravaginal bladder neck support prostheses have been developed, with preliminary studies showing similar excellent response rates in 80 percent of patients. Intrinsic urethral sphincter deficiency can be successfully treated non-surgically with peri-urethral collagen injection, with success in 50 percent of patients, or alternatively, with intra-urethral balloon-type plugs or in-dwelling mechanical valves.     

An Overview of Surgical Treatment for Female Stress Urinary Incontinence

Purpose of Review

We aimed to present an overview of recent data on the proven surgical techniques for female stress urinary incontinence (SUI) including their efficacy, safety, and adverse events.

Recent Findings

Surgical treatment of female SUI is the mainstay of urogynecological surgery, with two accepted gold standard techniques: Burch colposuspension and synthetic midurethral slings (MUS). Thorough understanding of the historical evolution of the surgical techniques before and after the introduction of integral theory is important. This theory enhances our comprehension for the continence mechanism of MUS, which are currently the level 1, grade A, recommended anti-incontinence procedures in all recent guidelines. However, in cases with specific contraindications, mesh surgery should be avoided. Burch colposuspension and autologous rectus fascia pubovaginal sling (RF PVS) procedures are the recommended surgical techniques with level 1 evidence in such cases and should be performed after a complete evaluation. Urethral bulking agents and artificial sphincters are the other options for severe and complicated cases. Because each surgical intervention for female SUI has inherent advantages and risks of complications, selection of the optimal surgical technique should be based on the risk-benefit ratio for every patient.

Summary

Comprehension of recent data derived from systematic meta-analyses and latest guidelines and knowledge of the safety, long-term efficacy, and possible adverse events of all currently accepted surgical techniques for female SUI provide an insight to properly counsel women and to select the optimal individualized anti-incontinence surgery.

     

盆腔器官脱垂及压力性尿失禁的相关因素分析

目的:探讨盆腔器官脱垂及压力性尿失禁的相关危险因素。方法:选择2007年1月至2016年1月在郑州大学第三附属医院盆底重建科行盆底重建术患者625例,将其中盆腔器官脱垂患者454例为A组,压力性尿失禁患者171例为B组,另选择体检的健康女性449例为对照组。分别统计分析其孕产次,是否绝经,有无子宫切除、慢性高血压、糖尿病、会阴裂伤、子宫肌瘤及阴道分泌物分析结果等资料,并进行单因素和多因素Logistic回归分析。结果:单因素分析示:A组子宫切除、已绝经、会阴裂伤患者所占比例均明显高于对照组(P0.05);B组慢性高血压、会阴裂伤的患者所占比例均明显高于对照组(P0.05);A组、B组多孕次(≥3次)、多产次(≥3次)患者所占比例高于对照组(P0.05),存在乳杆菌患者所占比例低于对照组(P0.05)。多因素Logistic回归分析示:子宫切除、已绝经、会阴裂伤、孕次≥3次、产次≥3次是盆腔器官脱垂的独立危险因素;会阴裂伤、孕次≥3次、产次≥3次是压力性尿失禁的独立危险因素。存在乳杆菌是盆底器官脱垂和压力性尿失禁的保护因素。结论:子宫切除、多孕、多产、会阴裂伤可能参与了盆腔器官脱垂及压力性尿失禁的发生发展,阴道乳杆菌的存在可能减少盆腔器官脱垂及压力性尿失禁的发生。     

Recent Advances in Tape Slings for Female Urinary Stress Incontinence

Sling therapy is the enhanced surgical support of the urethra. In this article, the history of the use of slings for the surgical treatment of female urinary stress incontinence is reviewed, and the usual surgical routes for retropubic (transvaginal) or transobturator tape passage are described. The latest innovation in sling therapy is the use of minislings, which are short tape mesh implants inserted through a single vaginal incision; these slings may be placed in an office setting. Outcomes data are either lacking or suggest a considerable decrement of effectiveness of unstabilized minislings over full-length slings; however, the short-term efficacy of a stabilized, adjustable minisling is 97%. These results suggest benchmark effectiveness associated with full-length slings in a less invasive device that also has the capability of short-term adjustability.Key words: Minisling, Urinary stress incontinence, Retropubic sling, Transvaginal tape, Subfascial or transobturator sling, Suburethral slingUrodynamic stress incontinence (USI) is the leakage of urine through an incompetent urethra in the absence of a detrusor contraction.¹ The purest symptom of USI is urinary loss upon raising intra-abdominal pressure, as in coughing. Ten percent of middle-aged women report weekly incontinence,² although only 1 in 1000 women undergo curative surgery. USI may be complicated by intrinsic sphincter deficiency (ISD), detrusor overactivity or voiding disorder, or pelvic organ prolapse. USI is amenable to physical therapy and to surgery. Drug therapy to remedy a structural defect has been understandably disappointing. Bulking agents have a role in treating women with ISD, those who have undergone repeat surgery, or those medically unfit for surgery.     

阴道穹窿膨出与尿失禁的关系

压力性尿失禁(SUI)是老年女性常见疾病。国外大量研究证实,阴道穹窿膨出与尿失禁有密切关系。分娩损伤,绝经后激素水平低下,主韧带-宫骶韧带复合体薄弱,妇科手术后的盆底损伤,以及长期咳嗽、便秘等引起腹压增加的疾病是阴道穹窿膨出的病因。阴道支持结构的薄弱及破坏导致阴道穹窿膨出,阴道穹窿膨出的患者,11%有SUI症状。近年来,阴道穹窿膨出的发病率逐年上升,针对病因积极预防和治疗阴道穹窿膨出,可使广大中老年妇女免受尿失禁的困扰,提高生活质量。现就阴道穹窿膨出与尿失禁关系的研究及治疗进展进行综述。     

Stress Urinary Incontinence Six Months Post Laparoscopic Sacrocolpopexy

ObjectiveTo determine the incidence of postoperative stress urinary incontinence (SUI) after laparoscopic sacrocolpopexy (LSCP) in women without preoperative symptoms or signs of SUI.MethodsWe conducted a retrospective chart review of all cases of LSCP over a five-year period in a major tertiary centre to identify cases of SUI at the six-month follow-up visit. Patients did not have demonstrable preoperative SUI with prolapse reduction techniques, and they did not have prior or concomitant SUI surgery.ResultsOf 31 women, only two had SUI at six months after LSCP, with one requiring surgery.ConclusionWe do not recommend concomitant prophylactic surgery for SUI at the time of LSCP in women who do not have objectively demonstrable SUI before surgery.     

超声检查在女性压力性尿失禁中的应用

压力性尿失禁（SUI）是影响中老年女性生活质量的常见病、多发病,其主要是由于盆底正常形态结构的破坏及功能障碍所致。二维超声显像能够清晰显示盆底结构及其在不同状态下的动态变化,特别是对尿道、膀胱及周围结构的显示有独特的优越性,而且也能动态显示近年兴起的吊带术后吊带位置的改变等;三维超声显像不仅能够清晰显示女性盆膈裂孔的形态结构,而且能够显示吊带的形态及角度变化,从形态学及功能改变的角度为女性SUI的临床诊断及术后疗效评价提供参考依据。     

超声检查在女性压力性尿失禁中的应用

压力性尿失禁(SUI)是影响中老年女性生活质量的常见病、多发病,其主要是由于盆底正常形态结构的破坏及功能障碍所致.二维超声显像能够清晰显示盆底结构及其在不同状态下的动态变化.特别是对尿道、膀胱及周围结构的显示有独特的优越性,而且也能动态显示近年兴起的吊带术后吊带位置的改变等;三维超声显像不仅能够清晰显示女性盆膈裂孔的形...     

产后压力性尿失禁相关因素及研究进展

压力性尿失禁（SUI）是妇科常见病,以育龄妇女和绝经期妇女多发。导致其发生的主要原因为妊娠和分娩对盆底组织的损伤。产后是女性的特殊时期,盆底经历分娩导致的损伤,尚未恢复,尿失禁的发病处于较高水平。为预防及减少产后SUI,必须对其病因进行研究。通过对可能引起的相关因素分析寻找导致产后SUI的高危因素,为预防其发生寻找可行途径。通过文献分析发现,产后早期盆底肌训练对SUI有明显预防和治疗作用,但存在宣教不足及产妇缺少相应指导的困难,需由社区保健人员或产科医师尽早给予指导实施。     

产后压力性尿失禁相关因素及研究进展

压力性尿失禁（SUI）是妇科常见病，以育龄妇女和绝经期妇女多发。导致其发生的主要原因为妊娠和分娩对盆底组织的损伤。产后是女性的特殊时期，盆底经历分娩导致的损伤，尚未恢复，尿失禁的发病处于较高水平。为预防及减少产后SUI。必须对其病因进行研究。通过对可能引起的相关因素分析寻找导致产后SUI的高危因素，为预防其发生寻找可行途径。通过文献分析发现，产后早期盆底肌训练对SUI有明显预防和治疗作用，但存在宣教不足及产妇缺少相应指导的困难，需由社区保健人员或产科医师尽早给予指导实施。     

女性张力性尿失禁的手术治疗进展

张力性尿失禁 (SUI)的手术治疗已有 1 0 0多年的历史。传统手术主要包括三种术式 ,其中最为经典、疗效最为肯定的应属Burch手术。而现代外科手术的特点 ,趋向创伤小、并发症少、以及可行性高。为此 ,一些新的治疗SUI的手术方法和手术器械应运而生 ,尤以无张力阴道悬带 (TVT)更具安全、有效、创伤小的特点