Moore K H, Simons A, Mukerjee C, Lynch W
The Pelvic Floor Unit and Department of Microbiology, The St George Hospital, University of New South Wales, Sydney, Australia.
BJU Int. 2000 May;85(7):786-92. doi: 10.1046/j.1464-410x.2000.00619.x.
To determine whether patients with detrusor instability (DI) were more likely to have bacterial cystitis or significant bacteriuria on the urodynamic-test day than were women with a stable bladder.
A catheter specimen of urine was cultured (overnight in air) from 862 consecutive women at the time of urodynamic testing. The upper urinary tract was imaged, with cystoscopy when indicated, to exclude upper tract lesions or malignancy. The percentage of patients with pure idiopathic DI and those with mixed DI/genuine stress incontinence (GSI), in whom the urine culture was positive, was compared with the percentage who had a stable bladder (pure GSI or urodynamically normal) and a positive urine culture, both for the entire dataset and for women aged > or <65 years. Data were also analysed to detect the converse relationship; in those women found to have bacterial cystitis, the relative risk of being found urodynamically unstable or stable was determined.
The likelihood of bacterial cystitis occurring in patients with idiopathic DI (5.6%) was significantly greater than that in patients with GSI (1.1%; P = 0.009, Fisher's exact test). The proportion of patients with DI and significant bacteriuria (15. 4%) was significantly greater than that in patients with GSI (7.9%; P = 0.02). In patients with combined pure and mixed DI, bacterial cystitis was significantly more likely to occur (6.3%) than in GSI (P < 0.001), but bacteriuria was no more likely (12.5%, P = 0.09). Conversely, of those women found to have bacterial cystitis, the relative risk of having an unstable bladder was increased (+1.56), but for those with bacteriuria the relative risk of detrusor instability was not increased.
There was a significant association between idiopathic DI and bacterial cystitis, and we suggest that in some women with an unstable bladder, urinary infection may enhance detrusor contractility. Nevertheless, large-scale studies are needed of the temporal relationship between the onset of bacterial cystitis and the onset of DI.
确定逼尿肌不稳定（DI）患者在尿动力学检查当天发生细菌性膀胱炎或显著菌尿的可能性是否高于膀胱稳定的女性。
在尿动力学检查时，对862名连续就诊的女性进行导尿尿液样本培养（在空气中过夜）。对上尿路进行成像检查，必要时进行膀胱镜检查，以排除上尿路病变或恶性肿瘤。将单纯特发性DI患者和混合性DI/真性压力性尿失禁（GSI）患者中尿培养阳性的百分比，与膀胱稳定（单纯GSI或尿动力学正常）且尿培养阳性的患者百分比进行比较，比较整个数据集以及年龄大于或小于65岁的女性。还对数据进行分析以检测相反的关系；在那些被发现患有细菌性膀胱炎的女性中，确定其尿动力学不稳定或稳定的相对风险。
特发性DI患者发生细菌性膀胱炎的可能性（5.6%）显著高于GSI患者（1.1%；P = 0.009，Fisher精确检验）。DI且有显著菌尿的患者比例（15.4%）显著高于GSI患者（7.9%；P = 0.02）。在单纯和混合性DI患者中，发生细菌性膀胱炎的可能性（6.3%）显著高于GSI患者（P < 0.001），但菌尿的可能性无差异（12.5%，P = 0.09）。相反，在那些被发现患有细菌性膀胱炎的女性中，膀胱不稳定的相对风险增加（+1.56），但对于有菌尿的女性，逼尿肌不稳定的相对风险并未增加。
特发性DI与细菌性膀胱炎之间存在显著关联，我们认为在一些膀胱不稳定的女性中，泌尿系统感染可能会增强逼尿肌收缩力。然而，需要对细菌性膀胱炎发作与DI发作之间的时间关系进行大规模研究。
