Novel Conservative Treatment Mechanisms and Clinical Translation for Female Stress Urinary Incontinence
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摘要: 压力性尿失禁（stress urinary incontinence，SUI）是影响全球数百万女性的最常见盆底功能障碍之一。目前，临床实践中广泛采用的保守治疗方法疗效相对有限，亟需探索超越传统方法的创新治疗方案。近年来，物理治疗技术（如高强度聚焦电磁刺激）、再生医学与生物材料以及远程康复模式等新型保守治疗手段逐渐崭露头角，成为治疗SUI的潜在干预手段。这些疗法可能有效改善尿失禁症状并提升患者生活质量。对上述几种疗法在SUI中的作用机制及临床转化进展进行了综述，旨在为SUI的临床实践提供创新且实用的参考方案。Abstract: Stress urinary incontinence （SUI） is one of the most common pelvic floor dysfunctions affecting millions of women worldwide. Currently, conservative treatment methods widely adopted in clinical practice have relatively limited efficacy, necessitating the exploration of innovative treatment approaches beyond traditional methods. In recent years, new treatment methods such as physical therapy techniques （e.g., high-intensity focused electromagnetic stimulation）, regenerative medicine and biomaterials, and telerehabilitation models have gradually become prominent as potential interventions for SUI. These therapies may effectively alleviate urinary incontinence symptoms and improve the quality of life for patients. This review discusses the mechanisms of action and clinical translation progress of several aforementioned therapies in SUI, aiming to provide innovative and practical reference solutions for clinical practice in SUI management.
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图 1 女性SUI多机制病理与治疗靶点示意图
注：PRP 富血小板血浆；HIFEM 高强度聚焦电磁疗法；LI-ESWT 低强度体外冲击波疗法。
Figure 1. Schematic diagram of multi-mechanism pathophysiology and therapeutic targets in female stress urinary incontinence （SUI）
表 1 SUI新型保守治疗的疗效与特性对比
Table 1. Comparison of efficacy and characteristics of new conservative treatment for SUI
治疗方式 主要作用机制 疗程 疗效维持时间
（单位：月）优势 局限 参考文献 HIFEM 非侵入性诱发深层肌肉收缩，增强肌力与耐力 8～12次/4～6周 约6～18个月 无创、操作简单，尤其适用盆底肌力弱者 无法直接改善结缔组织松弛，对重度患者效果有限 [12，16−17] CO2激光 促进新胶原纤维的形成 3～5次/3～4月 约12-～24个月 微创、安全，
对与尿道及阴道结缔组织松弛患者疗效较好不能直接改善肌肉力量，对重度盆底组织脱垂/萎缩者效果欠佳 [22−24] Li-ESWT 促进血管生成和肌肉再生 6次/8周 约12～24个月 无创、副作用小，促进整体修复，协同改善多个机制 个体差异大，需多次治疗，长期效果待观察 [28，30−31] 干细胞注射 促进组织修复和再生 单次（可重复） * 再生潜力大，综合修复组织 临床数据有限，安全性需进一步验证 [33，38] PRP 促进组织再生、增强胶原蛋白生成、减轻炎症 2次注射，间隔4～6周 约3～6个月 取材自体，微创，安全性高 作用时间有限，需多次注射 [40−42] 尿道填充剂 提升尿道体积，增加闭合压力 单次，中位手术时间为9min 约24～36个月 即刻改善症状，操作简便，微创，耗时短 需重复注射，存在诸如尿路感染和尿潴留等多种并发症 [46−49] mHealth APP+PFMT 实时监测患者训练情况，可视化反馈 长期坚持训练 依赖训练持续性 无创，经济，可及性高 需患者主动参与 [53，55] *目前临床研究随访时间有限，远期疗效尚待观察。 
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