Stress urinary incontinence should be done early treatment b

If the elderly suffering from urinary incontinence need to visit the hospital in time, because the drug on the urinary incontinence of the little effect and harm, he does not recommend patients to unauthorized use.

Due to the highest incidence of stress urinary incontinence, and the greatest harm, the patient found that they have urinary incontinence symptoms need to be treated in time to the hospital, in the week before treatment patients need to do "urinary diary."

For the urgency of urinary incontinence, the condition is not serious patients can be pelvic training, levator ani training, bladder rehabilitation training and other means of self-regulation. In the diet and life, to avoid and limit caffeine-containing foods and drugs, such as coffee, tea, cola, chocolate and so on. Restricted drinking, carbonate drinks, orange juice, spicy food and foods containing artificial sweeteners. No matter what type of urinary incontinence, if the inconvenience of life should go to the hospital to timely treatment, so as soon as possible to cure.

Summary of stress urinary incontinence cause.

The cause of stress urinary incontinence is mainly pided into four aspects: from the bladder reasons, such as detrusor hyperreflexia and detrusor instability, the bladder sudden quenchless contraction, bladder pressure rise sharply and acute urinary incontinence caused by low detrusor areflexia or reflection;From the urethra reasons such as urethral sphincter dysfunction and machinery in the urethral obstruction;From aspects of the bladder urethral support around;Stress urinary incontinence.

Stress urinary incontinence explained in detail:

The cause of stress urinary incontinence:

The cause is various, urinary incontinence and urinary incontinence in the crowd of different age, sex, type of composition have different features.For example, women with stress urinary incontinence, the most common urge incontinence, continuous leakage in girls often to speak up to ectopic ureter;In men with prostate hyperplasia of urge incontinence and circumfuse incontinence and postoperative urinary incontinence of prostate is the most common.Urinary incontinence bring patients thought burden, even lead to abnormal.Therefore, this paper discusses the causes of urinary incontinence, classification, diagnosis and treatment is of great significance.

Urinary tract under normal urine storage function mainly depends on the impact of the nervous system and the coordination of activities under the control of the bladder urethra.From urine flow dynamic perspective, realizing the function of urine LuZhengChang urine storage under necessary conditions are: bladder pressure (normal average of 0.98 a 1.47 kPa or 10 ~ 15 cmh2o) below the urethral pressure (normal average of 3.92-5.88 kPa or 40-60 cmh2o).In the process of the bladder filling, to maintain a low pressure is dependent on the nervous system of detrusor inhibitory effect and good adaptability and stability of the bladder itself (there is no no inhibitory contraction);To maintain a consistently higher than in the urethra bladder pressure resistance, depends on the nervous system of detrusor. Sphincter accurately coordinating role, in addition, also requires near side and distal muscle to keep proper tension, and bladder neck and posterior urethral structure integrity and normal anatomical position.Once the above link under the influence of certain pathological conditions, the urethral pressure intermittent or continuous below the bladder pressure condition will cause urinary incontinence.Therefore, according to the above characteristics of the pathophysiology of urinary incontinence, urinary incontinence can be roughly pided into the following two aspects.

1. The reasons from the bladder

(1) the detrusor hyperreflexia and detrusor instability: this kind of situation can make the bladder sudden quenchless contraction, bladder pressure rise sharply, causing acute urinary incontinence.At the same time, the bladder compliance often become smaller, the real effective capacity of the bladder.Therefore, urinate frequently, the presence of urinary frequency, urgency and other symptoms.The cause of detrusor hyperreflexia is often nervous system damage, such as the brain and spinal cord trauma, inflammation, tumor and degeneration, etc.Unstable bladder could be the cause of neurological, can also be nervous, such as the bladder's own specific or non-specific infection, radioactive cystitis, interstitial cystitis, bladder outlet obstruction, etc.In addition, many patients with unstable bladder and nervous system damage, nor anatomical abnormalities, urge incontinence in after treatment with bladder training can disappear completely, so some people think that, except in the physical structure or lesions, 80% of the patients the bladder may be psychological or mental instability.

(2) the detrusor areflexia or low reflection: in this case, to increase bladder compliance, bladder, considerably more than the normal maximum capacity, the actual capacity because of detrusor smooth muscle, elastic fiber, such as organization extremely elongated, limit the infinite increase of bladder capacity, thus eventually bladder pressure, after more than the urethral pressure automatic leakage, the so-called circumfuse incontinence, this is a failure in function of forced urinous muscle, the result of chronic urinary retention.Causes of detrusor the pathology can be nerve, such as the sacral spinal peripheral nervous system damage (diabetes, pelvic surgery, trauma, etc.), can also be a serious within the bladder neck or urethral obstruction, such as, hyperplasia of prostate, urethral stricture, bladder neck fibrosis posterior urethral valve, distal muscle spasm, etc.

2. The reasons from the urethra

(1) the urethral sphincter dysfunction: this kind of functional disorder caused by nervous system damage, can be characterized by nearly, distal muscle cramps (such as around the spinal cord or nerve damage, mental urinary retention when can have the distal muscle spasm;Thoracic and lumbar spinal sympathetic efferent to more damage or peripheral nerve plexus damage, can cause near side sphincter relaxation state), also can show the close, distal sphincter (such as nervous system damage involving the parasympathetic nerve and pudendal nerve comes out, the distal muscle, went into a state of relaxation, such damage seen in severe horsetail nerve syndrome or pelvic widely cleaning after surgery.When the sympathetic nerve hypogastric nerve or basin of parasympathetic nerve damage, the bladder neck and near side urethra hypotonia, went into a state of relaxation.Filled with the former often leads to functional obstruction, cause urinary incontinence, the latter often leads to urethral resistance reduction, stress urinary incontinence.

(2) the machinery in the urethral obstruction: common at hyperplasia of prostate, urethra stricture, posterior urethral valve, etc., are the result of the urinary tract obstruction caused urge incontinence, also can cause circumfuse incontinence.

(3) from aspects of the bladder urethral support around the reason: the normal anatomy of the bladder urethra position, in the urinary tract implementation in urination function has a certain significance, especially for women.Bladder urethra to maintain the normal anatomic position depending on the support of the surrounding tissue, especially at the bottom of the pelvic muscle tissue and organs such as the uterus, vaginal.As a result of the uterus, rectal surgery, multiple births or hormonal changes that support organizations have been damaged or becomes weak, will affect the normal position bladder, urethra, especially at the bottom of the bladder and urethra bladder neck position.At this time, such as abdominal pressure rise suddenly, heighten the pressure equivalent to the bladder and urethra at the same time, the result in bladder pressure lifts suddenly, and urethral pressure failed to rise accordingly, the generate stress urinary incontinence.

Etiology and pathogenesis: female urethral an average of 3.5 ~ 3.5 cm long, the male urethra is shorter.Functional urethral length in young men and women are about 3 cm, proximal urethra three-quarters of women, equivalent to the men from the bladder neck to the length of the membrane urethra.Around the structure including external sphincter muscle of female urethra are far more men for the weak.The proportion of female urethra circular muscle and longitudinal muscle is 1:8, display circular muscle of the weak.

Female urethral \"S\" shaped.By pelvic fascia to keep within the bladder neck, urethral mouth connected to the pubic bone, forming Angle after bladder urethra.Pelvic fascia including cervical tissue adjacent to the pubic bone tissue and urinary tract, namely the proximal urethra and bladder neck adjacent tissues, including urethra pubic ligament is attached to the pubic symphysis, on both sides in the pubic bone before and after the two sides, fan above and lateral distribution with the urethra, urethral before the pubic ligament is connected with the clitoris ligament, and ligaments are connected to one form tendons bow with the clitoris ligament.When these support tissue damage, weakened or with congenital dysplasia, at the bottom of the bladder can prolapse, decreased urine road section, changed the urethra and bladder after Angle of normal Angle of stress urinary incontinence.

Stress urinary incontinence for many reasons, but its essence can be pided into two categories, one is for supporting urethral tissue damage caused;Another kind is urethral lesions and sphincter dysfunction, but various factors often together, make the processing of urinary incontinence is more complicated.

1) urethral support the organization's weak or damage: congenital dysplasia in childhood or youth.Middle-aged disease is due to malnutrition, disease caused by physical weakness or lack of exercise at ordinary times, or more to pregnancy and childbirth, especially had the injured.Make the pelvic and vaginal muscles.Older onset is decreased due to the female hormone, often make the urethra and bladder trigone and submucosal vein plexus thinner cortex on degradation, reduce the blood supply and mucosa, the epithelial tissue of urethra and bladder hypotonia, pelvic floor muscle atrophy.Hysterectomy, vaginal bulging anterior wall repair, repair of urinary fistula and extensive pelvic surgery, etc., are may directly damage ligaments of urethra and cause stress urinary incontinence.Chronic cough caused by long-term repeated abdominal pressure rise suddenly, also can cause urethral support ligament.

Itself factors: 2) urethra sphincter dysfunction caused urinary incontinence for many reasons, such as congenital dysplasia, malnutrition, disease, bladder and urethra, vaginal surgery, caused by urethral support structure weaken the bladder and urethra is backward, move, rotate without urethral sphincter of oddi dysfunction.The length of the urethral itself is associated with stress urinary incontinence. Don't agree.Most people believe that even if the functional urethral shorter, does not necessarily occur urinary incontinence, but some must be functional urethral length shortening associated with urinary incontinence.

(2) the classification of female stress urinary incontinence: classification and creating the mechanism of stress urinary incontinence, the correct classification is helpful to choose the ideal surgical operation in the hope of better curative effect.The more common form of stress urinary incontinence is as follows:

O: as the typical history of stress urinary incontinence, but failed to get clinical and urine flow dynamic check and confirm.Image urine dynamics test, detrusor resting stage bladder neck and proximal urethra closed, and located in the edge of pubic symphysis or above.Stress state of the bladder neck and move down the proximal urethra and open.

Type I: detrusor resting stage bladder neck closure and is located in the lower edge of the pubic symphysis or above, under the stress state of bladder neck and proximal urethra open and down, but down distance is less than 2 cm, not or only slightly bulging of the bladder.

Ⅱ A detrusor resting stage bladder neck closure, located at the lower edge of the pubic symphysis or above, under the stress state of bladder neck open proximal urethra, A drop in urethra distortion bulging bladder signs, such as incontinence significantly increased abdominal pressure.

Ⅱ type B: detrusor resting stage bladder neck closing and located at the lower edge of the pubic symphysis or under, under the stress state can't continue to fall or drop, but open the proximal urethra and incontinence.

Ⅲ type: detrusor rest period after bladder neck urethra in open state, near the urethra lose function of urinary continence, abdominal pressure slightly elevated or only gravity can appear obvious urinary incontinence.

The pathogenesis of:

Female urethral an average of 3.5 ~ 3.5 cm long, the male urethra is shorter.Functional urethral length in young men and women are about 3 cm, proximal urethra three-quarters of women, equivalent to the men from the bladder neck to the length of the membrane urethra.Around the structure including external sphincter muscle of female urethra are far more men for the weak.The proportion of female urethra circular muscle and longitudinal muscle is 8. Display circular muscle of the weak.

Female urethral S shaped by pelvic fascia to keep the bladder neck, urethral mouth connected to the pubic bone, forming Angle after bladder urethra.Pelvic fascia including cervical tissue adjacent to the pubic bone tissue and urinary tract, namely the proximal urethra and bladder neck adjacent tissues, including urethra pubic ligament is attached to the pubic symphysis on both sides.Pubic bone before and after the two sides, fan above and lateral distribution with the urethra, urethral before the pubic ligament is connected with the clitoris ligament, and ligaments are connected to one form tendons bow with the clitoris ligament.When these support tissue damage, weakened or with congenital dysplasia, at the bottom of the bladder can prolapse, decreased urine road section, changed the urethra and bladder after Angle of normal Angle of stress urinary incontinence.

symptoms

The symptoms of stress urinary incontinence

Female stress urinary incontinence of classification:

Female stress urinary incontinence of parting and creating the mechanism of stress urinary incontinence.The correct classification helps to choose the ideal surgical operation or in order to get a better curative effect.The more common form of stress urinary incontinence is as follows:

O: as the typical history of stress urinary incontinence, but failed to get clinical and urine flow dynamic check and confirm.Image urine dynamics test detrusor resting stage bladder neck and proximal urethra closed, and located in the edge of pubic symphysis or above.Stress state of the bladder neck and move down the proximal urethra and open.

Ⅰ type: detrusor resting stage bladder neck closure and is located in the lower edge of the pubic symphysis or above, under the stress state of bladder neck and proximal urethra open and down, but down distance is less than 2 cm, not or only slightly bulging of the bladder.

Ⅱ A detrusor resting stage bladder neck closure, located at the lower edge of the pubic symphysis or above, under the stress state of bladder neck open proximal urethra, A drop in urethra distortion bulging bladder signs, such as incontinence significantly increased abdominal pressure.

Ⅱ type B: detrusor resting stage bladder neck closing and located at the lower edge of the pubic symphysis or under, under the stress state can't continue to fall or drop, but open the proximal urethra and incontinence.

Ⅲ type: detrusor rest period after bladder neck urethra in open state, near the urethra lose function of urinary continence, abdominal pressure slightly elevated or only gravity can appear obvious urinary incontinence.

The classification of urinary incontinence:

According to different standards, urinary incontinence can be a variety of classification schemes, so the literature often visible to a variety of different terms, bring to clinical work must be chaos.

1. The common classification in the literature

(1) by age: children with urinary incontinence, adult incontinence, senile urinary incontinence.

(2) by sex: male urinary incontinence, female urinary incontinence.

(3) according to the characteristics of urinary incontinence: continuous urinary incontinence, urinary incontinence, completeness, urinary incontinence, intermittent urinary incontinence (nocturia) at night.

(4) according to the etiology: neurogenic urinary incontinence, urinary incontinence was obstructed, traumatic urinary incontinence, spirituality incontinence, congenital urinary incontinence.

(5) by urine flow dynamic characteristics: genuine stress urinary incontinence (urethral sphincter dysfunction), detrusor hyperreflexia or unstable [urge incontinence or (and) circumfuse incontinence], false incontinence (urinary retention circumfuse incontinence), congenital anomaly of urinary incontinence.

2. The international standard classification

Stress urinary incontinence (1) : refers to the patient when hard (sneezing, laughing, cough, sudden high lift heavy things, such as internal pressure, and so on and so forth) of involuntary leakage of urine.Its etiology is still not very clear, however, there have been several theories from the perspective of physiology to explain the stress urinary incontinence.(1) the urethra length;(2) Angle of bladder urethral defect;(3) increased intra-abdominal pressure, to the near side of urethral pressure transmission obstacles, etc.

(2) urge incontinence: refers to the accompanied by strong urinate involuntary leakage of urine.Urge incontinence can be further pided into motion again urge incontinence and feel urge incontinence.The former with detrusor without inhibitory contraction, the latter without the detrusor inhibitory contraction, namely strong urinate, not because of lack of inhibitory detrusor contraction, but caused by local factors.Urge incontinence is sometimes similar to genuine stress urinary incontinence, it can be a source of nerve sex, also be neurogenic causes, such as radioactive cystitis, interstitial cystitis, urinary tract infections, carcinoma in situ or mental disorders.It must be pointed out that genuine stress urinary incontinence and urge incontinence pathogenic factors could be the same, therefore, only according to the clinical manifestations of impossible to identify.Urge incontinence, for example, the patient cough or force, also can cause bladder reflex contraction.The situation has several different names, such as \"detrusor instability\" or \"detrusor dyssynergia\" and so on, at this point, can produce a brief incontinence.

(3) complete incontinence: serious sphincter dysfunction, i.e. without coughing and not hard also leak urine.At this time of the urethral pressure is always below the bladder, so the patients with persistent urinary leakage and residual urine volume is not much.Supine when urination control improve, but are not always the case;And leakage of urine when stand or walk.

(4) reflection incontinence: under the condition of lack of urinate, caused by spinal cord reflex activity within the spontaneous discharge of urine.Commonly seen in sacral on central nerve damage.Bladder sensation not to the brain, the sacral spinal low-level micturition center reflection.Generally no urination feeling, with detrusor hyperreflexia.Patients, without consciousness of bladder fullness or micturition unleashed a small amount of urine.The residual urine volume increase such patients or not, depends on the state of the urethral sphincter.

(5) spiritual urinary incontinence: as a psychiatric symptoms rarely exist alone.Its performance is that, in not the right time and place, the patient urinate at any time.With its clinical manifestation varies widely, from the mental stress of mild symptoms of urinary frequency, urgency, urinary retention, even upper tract damage.Mental urinary incontinence in patients with neurological diseases in a urinary tract syndrome.In these patients, can usually be confirmed in the mental disorder and there is a clear relationship between the occurrence of urinary tract symptoms.In addition, this kind of spiritual incontinence of psychotherapy or mental drug treatment has a good response.Urinary incontinence problems also have spiritual factors.

Circumfuse incontinence (6) : refers to the full bladder and detrusor contractions, just due to bladder pressure exceed the maximum pressure occurs of urinary bladder pressure the involuntary leakage of urine.Cause damage to the nervous system without reflex bladder and bladder outlet obstruction caused by the nervous system lesions often can appear circumfuse incontinence, its characteristic is automatic urine flow from high to low pressure area, as the bladder and sphincter pressure reduced pressure in balance and stop automatically, so the cycle.Due to cough vigorously can increase urine output, so sometimes confused with stress urinary incontinence, it must be paid to the clinical attention.Circumfuse incontinence, physical examination often can touch and a swelling in the bladder, with a large number of residual urine and stress urinary incontinence, no such signs.

check

Stress urinary incontinence

1, urine flow dynamic test: normal detrusor reflex, stress urinary incontinence maximum urinary flow rate increased significantly, when the internal pressure decrease during urination, mild bladder pressure from 5.9 to 5.9 kPa, from 2.5 to 2.5 kPa moderate, severe lower than 1, 96 kPa.Urethral pressure drop, the maximum urethral pressure decreases obviously, from the supine position to stand, the urethral closure pressure drop.

2, leakage point pressure (LPP) : the piezometric tube into the bladder and bladder filling, recorded in the bladder urethral leakage when pressure, the pressure is the leakage point pressure.Mild mostly higher than 11.8 kPa, severe mostly below 5.88 kPa.

3, the largest functional bladder capacity and determination of residual urine were normal.

4, urinary bladder imaging: normal bladder after Angle should be 90 ° ~ 100 °, urethral axis and stand on the vertical line, form a, about 30 ° Angle of urethra, bladder neck above the edge of pubic symphysis.Stress urinary incontinence, the Angle disappeared after bladder, urethra, bladder neck below the edge of pubic symphysis, urethral Angle increases, the bladder neck funnel shaped and prolapse, urethra shaft in different degree of downward and backward rotation.Green, it can be pided into two type: type Ⅰ, urethral axis of normal, but after the urinary bladder Angle increases;Ⅱ type, bladder after urethral Angle disappeared, increased abdominal pressure down, urethra distortion make urethral Angle increases, the urethra dip Angle 45 ° > > 90 °, sometimes weak bladder neck support organizations concerned, severe symptoms and treatment of difficult.McGurie thereafter proposed to intrinsic sphincter urethra function decline of stress urinary incontinence named Ⅲ type.

The diagnosis

The diagnosis of stress urinary incontinence

Diagnosis:

Diagnostic criteria for stress urinary incontinence:

1. Normal urinalysis, urine culture negative.

2. Check normal nerve.

3. The anatomical support weak (swab test, X-ray or urethra mirror check).

4. Confirm in pressure situations have excessive urine (pressure experiment or pads).

5. Bladder pressure measuring figure or urethra bladder pressure normal (normal residual urine volume, bladder capacity and feel normal;No not autonomy detrusor contraction).

Differential diagnosis:

Excessive activity 1. The bladder disease: refers to the bladder filling, detrusor involuntary contraction caused by frequent urination, urgency and urgency incontinence syndrome, symptoms and stress incontinence have similarities, but life bladder neck test negative, bladder urethra imaging Angle after normal bladder urethra, urine dynamics test in normal urethral pressure;Bladder detrusor pressure heighten, hyperreflexia.

2. Circumfuse incontinence: refers to the bladder bloated occurs when the randomness of urination, the patient can feel no urination, still have a lot of residual urine in bladder after micturition, therefore, also known as chronic urinary retention or false incontinence, often secondary to this kind of urinary incontinence in benign prostatic hyperplasia, diabetic neuropathy, and spinal cord injury.

3. True urinary incontinence: as the sphincter of the bladder and urethra sphincter dysfunction, drips continuously urine from the urethra, patients feel no urination, urinary bladder is always in a state of emptiness.

4. Neurogenic urinary incontinence: is caused by the diseases of the nervous system of the bladder, urethra dysfunction, common in cerebrovascular diseases, such as Parkinson's disease and spinal cord injuries, according to the type of the disease, can appear the urgency of the detrusor hyperreflexia incontinence or reflected weak circumfuse incontinence.

5. Urethral perticulum: see more at female, because within perticulum after urination urine, so, when walking upright or hard urine can be subsequently outflow, its performance stress urinary incontinence, but performance for urethral perticulum patients after urination urine leakage;Urine after vaginal anterior wall cystic neoplasm, squeeze the mass visible urine or purulent fluid flow, the urethra and urethral pressure screening colonoscopy is visible to the perticulum.

Bulging 6. The bladder: a history of urinary incontinence, and with ventral sense of belly and pubic hair, check the bladder residual urine, exertion of vaginal anterior wall surfaces and angiography after urethra bladder urethra slope Angle are within the normal range, Angle and urethra bladder bulging line of vaginal symptoms improved after anterior wall repair, and stress incontinence has no obvious improvement after surgery.

7. The urine leakage: urine drips through urethral fistula around the hole rather than through the urethra outflow, common in ectopic opening of ureter and bladder vagina fistula, ureteral diseases such as vaginal fistula, by asking the history, detailed examination, the site search and leakage, generally it is not difficult to identify.

treatment

The treatment of stress urinary incontinence

Summary of the treatment of stress urinary incontinence.

Stress urinary incontinence non-surgical treatment has pelvic floor muscle training, biofeedback, electrical stimulation and drug treatment, etc.The main purpose of stress urinary incontinence surgery has two, one is to restore the normal anatomy of the bladder neck posterior urethral position;The second is increased in the posterior urethral pressure.Remedy before dealing with patients for detailed evaluation.

Tooth stress urinary incontinence in detail treatment:

The treatment of stress urinary incontinence:

1. Non-surgical treatment of stress urinary incontinence

Non-surgical treatment has pelvic floor muscle training, biofeedback, electrical stimulation and drug treatment, etc.Pelvic floor muscle training refers to the contraction of anal sphincter, by using the method of correctly vagina sphincter and urethral sphincter, to strengthen the patients of pelvic floor muscle tension, alleviate bladder urethra down, the degree of enhancement of urethral sphincter sonourethrography.membranous closure mechanism.Biofeedback therapy refers to using a urine tube electrode, inserted into the urethra, record the patient sphincter activity of electromyography change, under the guidance of doctors, patients, according to the change of emg, of finding the right approach contraction urethral sphincter.Through this kind of bioelectricity record, display, and then feedback to the patient, the patient can quickly master the correct method of shrinkage urethral sphincter, significantly improve the effect of pelvic floor training.Electrical stimulation treatment by electrode anus or vagina electrodes to stimulate the pelvic floor muscles in order to achieve therapeutic purposes.Drug therapy there are two main types: one is the estrogen drugs, pharmacological mechanism to restore the urethra mucous membrane and mucous membrane and loose connective tissue rich in blood vessels, increasing the urethral closure function;Another kind of drug is alpha agonists, can enhance the bladder neck and proximal urethra smooth muscle tension, improve the posterior urethral sonourethrography.membranous closure.

2, the surgical treatment of stress urinary incontinence

The main purpose of stress urinary incontinence surgery has two, one is to restore the normal anatomy of the bladder neck posterior urethral position;The second is the increase in the posterior urethral pressure, improve the posterior urethral sonourethrography.membranous closure mechanism.

(l) before laparoscopic vaginal wall suspension: also known as' Burch vaginal wall hanging art, is the most commonly used surgical operation after pubic: mainly applied to O. Ⅱ type B stress urinary incontinence, type of Ⅲ stress urinary incontinence curative effect is poor.Laparoscopy in nearly a decade of development, making using laparoscopy to 'Burch vaginal wall hanging is possible.Abdominal 'Burch vaginal wall before the suspension of surgical indications: (1) O - Ⅱ B stress urinary incontinence.(2) no pelvic cavity, after the pubis or vaginal surgery history.(3) without severe lung disease.

(2) STAMEY bladder neck piercing suspension: as early as 1959 Pereyra attempting to bladder neck suspension with puncture, and later STAMEY the procedure is modified for many times, and combined with cystoscope observation to determine the suspension wire suspension and position firmness, significantly improve the curative effect of the operation, because STAMEY bladder neck piercing suspension has the advantages of small trauma, become one of the mainstream operation for stress urinary incontinence.

STAMFY bladder neck suspension surgical indications: (1) O - Ⅱ B stress urinary incontinence.(2) there is no obvious bulging bladder (less than Ⅱ degrees).

Bladder neck suspension (3) the cuff type: cuff type bladder neck suspension is widely regarded as one of the long-term efficacy of optimal operation, but the surgery has a lot of improvement, according to the material of the cuff is adopted by the different, can be called the anterior wall vaginal cuff suspension, pubic vaginal fascia suspension, and using artificial material Vesica cuff type suspension, etc.

Cuff of bladder neck suspension surgical indications: (1) O - Ⅲ stress urinary incontinence.(2) has no obvious bulging of the bladder (less than Ⅱ).(3) there is no history of pelvic surgery.

(4) the bladder neck mucosa down plant injection treatment of female stress urinary incontinence: female stress urinary incontinence occurs not only related to urinary tract down (such as O - Ⅱ B stress urinary incontinence). And also related to inherent urethra sphincter function (intrinsic sphincter dysfunction is Ⅲ stress urinary incontinence).Regardless of the bladder neck suspension surgery will restore the anatomical location of bladder neck posterior urethra and bladder neck suspension and cuff type can not only restore the anatomical level, also can increase the posterior urethral resistance in order to make up for the inadequacy of urethra intrinsic sphincter function.Pure of stress urinary incontinence caused by loss of urethra intrinsic sphincter does not see more, most with urethral excessive down stress urinary incontinence caused by mixing exists (i.e., O - Ⅱ B and Ⅲ mixed), therefore had bladder neck suspension in clinical curative effect of poor people often exists inherent urethra sphincter function loss phenomenon, to this kind of not considering urethral sphincter inherent factors and execute the cuff type bladder neck suspension performer, and then to the bladder neck cuff type suspension is extremely difficult, easy to cause damage to the bladder and urethra.So the bladder neck mucosa down plant injection is a good choice, the operation through cystoscope treatment, without having to cut any free any organization structure, operation safety, and can be repeated many times for injection until achieve better curative effect.Bladder neck mucosa down plant injection can increase the posterior urethral sonourethrography.membranous closure mechanism, such as at the same time with apparent bladder neck posterior urethral moving, poor curative effect.The surgery by cystoscope directly puncture injection bladder neck mucosa, or monitoring by bladder biopsy under cystoscope injection, but the more under the surveillance of cystoscope puncture injection by urethra.By injection of various kinds, such as autologous fat injection, collagen, all kinds of liquid absorbing compounds and balloon, etc.

Bladder neck mucosa down plant injection surgical indications: 1) no obvious down bladder neck posterior urethral type Ⅲ stress urinary incontinence.(2) did the other operation, poor curative effect, but relatively normal position of the urethra after bladder neck.(3) posterior urethral mucosa of bladder neck without obvious scar.(4) male urinary incontinence after radical resection of prostate.

In short, the treatment of stress urinary incontinence despite surgery is various, have their own advantages and disadvantages, but the most important thing is that when determining the treatment of stress urinary incontinence, dealing with patients for detailed evaluation, especially the urine flow mechanics test, determine the patient produces the leading causes of urinary incontinence, bladder detrusor function state, and the type of stress urinary incontinence, to correctly select the most suitable for patients of surgical operation, to achieve a better therapeutic effect.

care

Stress urinary incontinence care

Nurse:

Strengthen physical exercise, active treatment of various chronic diseases.Emphysema, asthma, bronchitis, obesity, intraperitoneal tumor, etc., can cause increased abdominal pressure and lead to urinary incontinence, should actively treat the chronic diseases, improve general nutritional status.At the same time to the appropriate physical exercise and pelvic floor muscle exercise.The easiest method is to wake up every morning and goes to bed at night before bed after recumbent, do 45 ~ 100 times each tightening the anus and on anal activity, can significantly improve the symptoms of urinary incontinence.

Diet to light, eat more contain cellulose rich food.

Diet: (the following information is for reference only, the details about the doctor)

1) the red jujube has ten, cooking cooked every day.

2) the red jujube five, Gordon euryale seed 50 grams, boil porridge to drink.

3) schisandra 10 grams, 10 grams black sesame seed, cultivated land 10 grams, brown sugar right amount add 500 ml water decoction.

The prevention of

The prevention of stress urinary incontinence

1. A good state of mind:

Be optimistic, open-minded mood, with a positive peace of mind, smiles to the life and work of the success and failure, stress and worry, learn to adjust mood and emotion.

2. To prevent urinary tract infections:

Get into the habit of urine after wipe toilet paper from front to back, avoid urethra infection.Before sex, couples with warm boiled water wash vulva, her empty them immediately after intercourse, wash the vulva.If after sexual intercourse in urine pain, frequent urination, can take drug urinary tract infection (3 ~ 5 days, rapid cure at the beginning of the inflammation.

3. Regular sex:

Research proves that menopause postmenopausal women continue to maintain the regular sex, can obviously delay the physiology degeneration of ovarian function of synthetic estrogen, reduce the incidence of stress incontinence, can prevent other age-related diseases at the same time, improve the level of health.

complications

Complications of stress urinary incontinence

80% of the patients with stress urinary incontinence bulging with bladder, but about half the patients with bladder bulging with stress urinary incontinence.

RELATED ARTICLES