| 中文摘要 |
有關應力性尿失禁（stress urinary incontinence, SUI）的病理生理學觀點仍有許多爭議，也許是因為由很多不同層面看同一現象而產生各種不同的觀察結果。因為尿失禁發生的原因來自骨盆底的肌肉、神經、結締組織當中，單一或數種合併損傷所造成的症狀。骨盆腔的支撐為骨盆橫膈（pelvic diaphragm），由提肛肌、尾肌主動支撐及內骨盆筋膜（endopelvic fascia）被動支撐構成。尿道的支撐、膀胱頸的功能及尿道肌肉的功能，都是維持排尿自制力（continence）的重要決定因子。此外，筋膜與肌肉連接機械性分離、支配的神經損傷、肌肉損傷等，都會影響排尿自制力功能。排尿自制力的機轉，包括神經、肌肉及結締組織等整體動態性膀胱控制系統，使膀胱可以將尿排空，並在腹壓急劇增加時保持不漏尿。很可惜的，這種動態性排尿自制力的控制系統，在討論手術治療時常被忽略，但這些對尿失禁機轉卻是非常重要。本篇文章主要根據Rovner, Ginsberg, Raz等學者提出4個影響排尿自制力的因素理論，及DeLancey提出應力－排尿自制力控制系統（stress-continence control system）， 與其他相關文獻，嘗試探討婦女應力性尿失禁的病理生理學機轉。手術對於應力性尿失禁可以有效地改善，卻不一定回復正常生理的功能，是一種經驗療法；惟有對排尿自制力機轉有更好的了解才能使治療方式，由經驗療法往針對病因治療的方向進展。 |
| 英文摘要 |
Stress urinary incontinence (SUI) is defined as the involuntary urine loss during an increase in intraabdominal pressure which is not associated with a concomitant detrusor contraction . The pathophysiology of stress urinary incontinence consists of multiple factors e.g. damage to muscle,nerve,fascia of the pelvic floor.It is pretty important to understand the underlyihg mechanism of stress urinary incontinence in women based throughout, the 'UCLA' theory proposed by Rovner et al and stress-contineiice control system proposed by DeLancey.'UGLA' theory depicts the concept of 4 important factors contributing to continence. composed of urethral changes during stress, coaptation and closure of the urethra length of the urethra, anatomic support and position of the urethra. These factors work in concert and may compensate for each other to maintain continence. The dynamic nature of the continence system comprises many important factors such as stress-continence control system,coordination, innervation, role of urethra (functional and anatomic) and vesicle neck Though anti-incontinence operations are effective in eliminating stress incontinence, these are empiric methods without altering never or muscle function A better under-standing of continence physio1ogy could change empirically based treatment to therapy directed at an exact recognition of the damage. |
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