Lemack G E, Zimmern P E
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Urology. 2000 Apr;55(4):506-11. doi: 10.1016/s0090-4295(99)00546-4.
To determine whether knowledge about previous surgical history for incontinence and responses to a validated lower urinary tract symptom questionnaire for women could identify those who should undergo urodynamic testing before surgery for stress urinary incontinence (SUI).
A retrospective analysis of all women who completed the Urogenital Distress Inventory-6 questionnaire (UDI-6) and then underwent complete urodynamic studies was conducted. The critical urodynamic diagnoses to determine before anti-incontinence surgery were defined as coexisting SUI and detrusor instability (DI), Valsalva leak point pressure less than 60 cm H(2)O, and DI alone in women suspected clinically of having SUI. Models were established for deciding who should undergo urodynamic studies on the basis of questionnaire responses and information about previous surgical history. Cost savings and the ability of the various models to identify patients with critical urodynamic diagnoses were calculated.
A total of 174 women completed the UDI-6 and underwent urodynamics studies. Sixty-two had SUI (36%), 54 had DI (31%), 18 had both SUI and DI (10%), and 19 women suspected of having SUI were found instead to have DI (11%). Among women with SUI, 39 had a Valsalva leak point pressure less than 60 cm H(2)O (63%). No group of question responses or combination of question responses and presence of previous incontinence surgery was able to identify all three critical urodynamic diagnoses with statistical significance. Still, the combination of a response of "2" or "3" to question 3 on the UDI-6 and a positive history of previous surgery would have identified 91% of the critical diagnoses, and a substantial cost savings would have been realized.
Using the UDI-6 and information obtained from the patient's history to determine who should undergo urodynamic testing before surgery for SUI can result in substantial cost savings without sacrificing patient care.
确定关于尿失禁既往手术史的知识以及对经过验证的女性下尿路症状问卷的回答，是否能够识别出那些在压力性尿失禁（SUI）手术前应接受尿动力学检查的患者。
对所有完成泌尿生殖系统困扰量表-6问卷（UDI-6）并随后接受完整尿动力学研究的女性进行回顾性分析。在抗尿失禁手术前需确定的关键尿动力学诊断定义为并存SUI和逼尿肌不稳定（DI）、Valsalva漏尿点压力低于60 cm H₂O，以及临床怀疑患有SUI的女性单独存在DI。基于问卷回答和既往手术史信息建立模型，以决定谁应接受尿动力学研究。计算成本节约情况以及各种模型识别关键尿动力学诊断患者的能力。
共有174名女性完成了UDI-6并进行了尿动力学研究。62名有SUI（36%），54名有DI（31%），18名既有SUI又有DI（10%），19名临床怀疑有SUI的女性实际被发现有DI（11%）。在有SUI的女性中，39名Valsalva漏尿点压力低于60 cm H₂O（63%）。没有一组问题回答或问题回答与既往尿失禁手术存在情况的组合能够具有统计学意义地识别出所有三种关键尿动力学诊断。尽管如此，对UDI-6问卷第3题回答为“2”或“3”并伴有既往手术阳性史的组合能够识别出91%的关键诊断，并且可实现大量成本节约。
使用UDI-6和从患者病史中获得的信息来确定谁在SUI手术前应接受尿动力学检查，可在不牺牲患者护理的情况下实现大量成本节约。
