這篇文獻回顧探討了女性壓力性尿失禁（SUI）的現況，強調了其在女性健康領域中仍然是一個普遍存在但未被充分認識和治療的問題。文獻中將女性壓力性尿失禁定義為與身體活動相關的任何非自願性尿液滲漏，例如運動、打噴嚏、咳嗽、大笑或彎腰所引發的漏尿。

文章中呈現了女性壓力性尿失禁的盛行率數據，指出女性壓力性尿失禁在年輕女性中的報告率為20-30%，在45至59歲的女性中達到高峰，盛行率約為30-50% 。儘管盛行率很高，但只有少數患者會尋求醫療協助，這凸顯了女性壓力性尿失禁治療領域中一個重要的差距 。作者認為，造成這種現象的原因包括未意識到問題的存在、認為這是老化的一部分、對治療選項缺乏了解、治療資源的匱乏、與醫療專業人員缺乏開放性的溝通，以及患者對人工網膜相關併發症的擔憂 。

在診斷方面，這篇文獻強調了全面評估的重要性，除了病史和身體檢查，還應使用驗證過的問卷評估患者的主觀症狀，這符合歐洲泌尿科協會的建議。客觀評估症狀的方法包括臨床測試，並在必要時進行尿路動力學檢查。由於不完全膀胱排空常見於尿失禁患者，超音波殘餘尿評估也是基礎檢查之一。膀胱日記也有助於指導生活方式調整。值得注意的是，對於非複雜性壓力性尿失禁，臨床數據顯示可以不進行尿路動力學檢查而成功治療，但在複雜病例中，是否使用尿路動力學檢查仍有爭議，需根據具體情況和專家意見決定。

在治療方面，骨盆底肌肉訓練被認為是首選的一線治療方法，前提是需要提供良好的指導和監督，這樣才能有效改善症狀。對於一線治療效果不佳的情況，中段尿道懸吊術和單切口吊帶術被列為二線治療選擇，然而，文章也指出了人們對人工網膜相關併發症的擔憂，導致這類手術的使用有所減少。此外，單切口吊帶術的長期療效仍然需要進一步確認。除了吊帶術，文章還提到了其他替代方案，例如尿道填充劑、恥骨後懸吊術和自體筋膜吊帶術。這些方法都有可靠的證據支持，但各自存在不同的副作用。對於嚴重且複雜的壓力性尿失禁，治療仍具挑戰性，目前自體筋膜懸吊術與人工尿道括約肌已被確立為主要治療方式，然而仍缺乏高品質的數據支持其效果。

總體而言，女性壓力性尿失禁是一個影響廣泛的健康問題，對患者的生活品質造成顯著影響。這篇文章強調了精確診斷的重要性，以及根據患者具體情況和偏好選擇合適治療方案的必要性。從生活方式調整、骨盆底肌肉訓練等保守方法，到不同類型的手術治療，醫學界持續在探索更有效、更安全的解決方案。未來的研究應繼續關注長期療效、患者報告的結果以及新興治療技術的發展，以期為女性患者提供更優化的照護。同時，加強患者教育和提高公眾對女性壓力性尿失禁的認識，將有助於及早發現和管理這個常見但常被忽略的疾病。

Background and objective: Stress urinary incontinence (SUI), defined as any involuntary leakage of urine associated with physical activity, remains underdiagnosed and under treated. This review aims to provide an updated overview of the prevalence, diagnosis, and treatment of SUI in women, drawing upon recent evidence-based literature and clin ical guidelines.

Methods: A systematic search of the MEDLINE database was conducted to identify only the most up-to-date and relevant studies published up to February 26, 2024, including the reference ESTER systematic review. The search was limited to systematic reviews published in the preceding 1 yr. Any additional included publications were limited to those published or referenced as part of the existing/current guidelines.

Key findings and limitations: Diagnosis of SUI involves a comprehensive assessment, including medical history, physical examination, and in some cases, invasive urodynam ics. Pelvic floor muscle training emerges as a first-line management strategy, showing efficacy in symptom improvement when good educational instructions and supervision are provided. Surgical interventions with midurethral and single-incision slings offer a second-line option, although concerns regarding mesh-related complications persist with a decrease in its use. Moreover, the long-term efficacy of single-incision slings remains to be confirmed. Urethral bulking agents, colposuspension, and autologous fas cial slings are existing alternatives supported by robust evidence, albeit with a different adverse event profile. Management of complicated and severe SUI remains challenging, with autologous fascial sling and artificial urinary sphincters being established treat ments, but high-quality data remain lacking.

Conclusions and clinical implications: Heightened awareness and accessibility to SUI treatment are imperative to address the gap between prevalence and medical care–seek ing behavior. Pelvic floor muscle training and surgical interventions represent key modalities. However, a notable escalation in invasiveness and complication rates when transitioning to surgical interventions is clear and has resulted in a hesitance among patients to proceed along the treatment continuum, particularly in light of mesh related complications. Ongoing research is necessary to optimize outcomes and ensure patient safety, particularly for complicated SUI where data on comparative effectiveness remain limited.