Farhat W, Bägli D J, Capolicchio G, O'Reilly S, Merguerian P A, Khoury A, McLorie G A
Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
J Urol. 2000 Sep;164(3 Pt 2):1011-5. doi: 10.1097/00005392-200009020-00023.
Academic research on pediatric nonneurogenic voiding dysfunction has long been hampered by the lack of a standardized reporting system for voiding symptoms. We evaluated the performance of a newly devised, objective instrument to quantify or grade the severity of abnormal voiding behaviors of children.
There were 10 voiding dysfunction parameters that were assigned scores of 0 to 3 according to prevalence, and possible total scores ranged from 0 to 30. The Dysfunctional Voiding Symptom Score was completed by 2 groups of patients. Group 1 consisted of patients 3 to 10 years old presenting to the pediatric urology clinic with a history of diurnal urinary incontinence, urinary tract infections or abnormal voiding habits. Group 2 consisted of an age matched cohort with no history of urological complaints presenting to hospital clinics outside of urology. Patients diagnosed with organic or anatomical disease, such as posterior urethral valves or meningomyelocele, were excluded from our analysis.
Group 1 consisted of 104 patients (female-to-male ratio 4:1) with a median symptom score of 14 and group 2 consisted of 54 patients (female-to-male ratio 1.3:1) with a median score of 4. The dysfunctional voiding odds ratio was 2.93 for females compared to that of males. Using receiver operating characteristics the optimum cutoff score was 6.026 (sensitivity 92.77% and specificity 87.09%) for females and 9.02 (sensitivity of 80.95% and specificity of 91. 30%) for males. In addition, we found certain questions to be more reflective than others of dysfunctional voiding symptoms in our population.
The Dysfunctional Voiding Symptom Score appears to provide accurate and objective, that is, numerical, grading of voiding behaviors of children. Comparative research studies of dysfunctional voiding diagnosis and response to therapy as well as objective measurements of treatment efficacy and outcomes analysis should be aided greatly by this system.
长期以来，由于缺乏用于排尿症状的标准化报告系统，小儿非神经源性排尿功能障碍的学术研究受到阻碍。我们评估了一种新设计的客观工具的性能，该工具用于量化或分级儿童异常排尿行为的严重程度。
有10个排尿功能障碍参数，根据发生率给予0至3分，可能的总分范围为0至30分。两组患者完成了排尿功能障碍症状评分。第1组由3至10岁的患者组成，这些患者因日间尿失禁、尿路感染或异常排尿习惯而到小儿泌尿外科门诊就诊。第2组由年龄匹配的队列组成，他们没有在泌尿外科以外的医院门诊就诊的泌尿系统疾病史。被诊断患有器质性或解剖性疾病（如后尿道瓣膜或脊髓脊膜膨出）的患者被排除在我们的分析之外。
第1组由104例患者组成（女性与男性比例为4:1），症状评分中位数为14分；第2组由54例患者组成（女性与男性比例为1.3:1），评分中位数为4分。女性排尿功能障碍的优势比是男性的2.93倍。使用受试者工作特征曲线，女性的最佳截断分数为6.026（敏感性92.77%，特异性87.09%），男性为9.02（敏感性80.95%，特异性91.30%）。此外，我们发现某些问题比其他问题更能反映我们研究人群中的排尿功能障碍症状。
排尿功能障碍症状评分似乎能为儿童排尿行为提供准确、客观（即数字化）的分级。该系统将极大地有助于排尿功能障碍诊断及治疗反应的比较研究，以及治疗效果的客观测量和结果分析。
