从妇科角度看间质性膀胱炎/膀胱疼痛综合征可能为某些病例提供治疗。

IF 1.4 Q3 UROLOGY & NEPHROLOGY Central European Journal of Urology Pub Date : 2022-01-01 DOI:10.5173/ceju.2022.106
Peter Petros
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引用次数: 1

摘要

简介:最近发表的间质性膀胱炎(IC)/膀胱疼痛综合征通过妇科脱垂治疗方案,与传统的治疗方法,如膀胱安装,不提供这种治疗背道而驰。脱垂方案,子宫骶韧带(USL)修复,是基于“后穹窿综合征”(PFS)。PFS在1993年迭代的积分理论中被描述。PFS包括可预测的频率、尿急、夜尿、慢性盆腔疼痛、排空异常和空后残留尿等共同出现的症状,由USL松弛引起,通过修复USL松弛而治愈或改善。材料与方法:对USL修复治疗IC的已发表数据进行分析与解释。结果:在许多女性中,髂胫束的发病机制可以解释为弱或松散的USL削弱了对其收缩的盆腔肌肉,提肛板(LP)和肛门联合纵肌(LMA)。现在虚弱的骨盆肌肉不能充分拉伸阴道,以阻止来自尿路上皮拉伸受体'N'的传入冲动到达排尿中心,在那里它们被解释为冲动。同样的无支持usl不能支持内脏交感/副交感内脏自主神经丛(VP)。多发性盆腔疼痛的通路解释如下:重力或肌肉运动刺激的传入VP轴突群发出“流氓”脉冲,皮层将其解释为来自多个终末器官的慢性盆腔疼痛(CPP);这解释了为什么CPP在几个站点中总是被感知到。对非Hunner's和Hunner's IC的治疗报告进行了分析,并用图表解释了IC与冲动的共同发生以及来自不同部位的慢性盆腔疼痛的表型。结论:妇科模式不能解释所有IC表型,尤其是男性IC。然而,对于那些从预测镜试验中获得缓解的女性,子宫骶韧带修复有很大的可能性可以治愈疼痛和冲动。在这种情况下,至少在探索性诊断阶段,将ICS/BPS纳入PFS疾病类别可能符合这些女性患者的利益。这将给这些女性很大的治愈机会,这是她们目前无法获得的。
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A gynecological perspective of interstitial cystitis/bladder pain syndrome may offer cure in selected cases.

Introduction: Recent publications of interstitial cystitis (IC)/bladder pain syndrome cure by a gynecological prolapse protocol, run counter to traditional treatments such as bladder installations which do not offer such cure. The prolapse protocol, uterosacral ligament (USL) repair, is based on the 'Posterior Fornix Syndrome' (PFS). PFS was described in the 1993 iteration of the Integral Theory. PFS comprises predictably co-occurring symptoms of frequency, urgency, nocturia, chronic pelvic pain, abnormal emptying and post-void residual urine, caused by USL laxity and cured or improved by repair thereof.

Material and methods: analysis and interpretation of published data showing cure of IC by USL repair.

Results: In many women, USL pathogenesis of IC can be explained by the effect of weak or loose USLs weakening two pelvic muscles which contract against them, levator plate (LP) and conjoint longitudinal muscle of the anus (LMA). The now weakened pelvic muscles cannot stretch the vagina sufficiently to prevent afferent impulses from urothelial stretch receptors 'N' reaching the micturition centre where they are interpreted as urge. The same unsupported USLs cannot support the visceral sympathetic/parasympathetic visceral autonomic nerve plexuses (VP). The pathway of multiple referred pelvic pains is explained as follows: groups of afferent VP axons stimulated by gravity or muscle movements fire off 'rogue' impulses, which are interpreted by the cortex as end-organ chronic pelvic pain (CPP) from several end organs; this explains how CPP is invariably perceived in several sites. Reports of cure of non-Hunner's and Hunner's IC are analysed with diagrams which explain co-occurrence of IC with urge and phenotypes of chronic pelvic pain from several different sites.

Conclusions: A gynecological schema cannot explain all IC phenotypes, especially male IC. However, for those women who obtain relief from the predictive speculum test, there is a significant possibility of cure of both the pain and the urge by uterosacral ligament repair. In this context, it may well be in such female patients' interests, at least in the exploratory diagnostic phase, for ICS/BPS to be subsumed into the PFS disease category. It would give such women a significant chance of cure, something denied to them for now.

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来源期刊
Central European Journal of Urology
Central European Journal of Urology UROLOGY & NEPHROLOGY-
CiteScore
2.30
自引率
8.30%
发文量
48
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