UPPによる女子尿失禁の検討

Abstract

In order to study female urinary incontinence, urethral pressure profile measurement and cystometry have been employed in 18 patients with stress incontinence who had no neurological disorder, 30 patients after panhysterectomy, 20 patients with urge incontinence due to various diseases and 32 normal women as control. In the control women, the mean value of maximum urethral pressure (UPmax) was 77 cmH2O with standard deviation of 13. In general, UPmax showed a tendency to decrease with increasing age. In the patients with stress incontinence, the mean value of UPmax was 45± 12 cmH2O, being significantly lower than that in the control group. A urethral closure pressure fell to zero during a deep cough in most of these patients. Cystometrograms ofthe 30 patients after panhysterectomy showed hypertonic pattern in 15 patients and normotonic pattern in the remaining patients. The mean value of UPmax in the former was 50± 11 cmH2O which was significantly lower than the value of 64± 14 cmH2O in the latter. Seven patients with hypertonic bladder had overflow incontinence and showed the decrease of the urethral closure pressure to zero, along with a gradual elevation of intravesical pressure due to vesical distension. In all of 14 patients with urge incontinence due to neurological diseases, chronic cystitis and infravesical obstruction, a detrusor hyperreflexia was observed by ordinary cystometry, and values of UPmax were normal in 12 of these patients. In 4 of 5 patients with urge incontinence, who had no evidence of causative disease, a detrusor hyperreflexia was observed by cystometry at standing position only, and values of UPmax were below 60 cmH2O in 3 of these 4 patients. A possible clinical significance of urethral pressure profile in female patients with urinary incontinence is discussed.