Cormier Luc, Ferchaud Jerome, Galas Jean-Marie, Guillemin Francis, Mangin Philippe
Urology Department and Institut Régional de Réadaptation, University Hospital of Nancy-Brabois and School of Public Health Equipe D'Accueil, Faculty of Medicine, Vandoeuvre-les-Nancy, France.
J Urol. 2002 May;167(5):2083-7.
The diagnosis of bladder outlet obstruction in women by pressure flow study may be difficult because there are several definitions of bladder outlet obstruction, several parameters and no standard cutoffs. We evaluated the ability of pressure flow studies to separate women into unobstructed, equivocal and obstructed groups.
In a prospective study 85 women with lower urinary tract symptoms underwent clinical evaluation, including physical examination, voiding cystourethrography, endoscopy, flow rate and post-void residual volume measurement. A pressure flow study was performed 15 days later. The pressure flow study parameters were maximum flow, post-void residual volume, detrusor pressure at maximum flow, vesical pressure at maximum flow, area under the curve of detrusor pressure during voiding and area under the curve of detrusor pressure during voiding adjusted for voided volume. After considering the clinical evaluation 2 urologists classified the patients into 3 groups, namely unobstructed, equivocal and obstructed, as the traditional classification. Linear discriminant analysis was then performed using the traditional classification and pressure flow study data.
Mean patient age was 55 years (range 18 to 83). According to the traditional classification there were 36 unobstructed, 28 equivocal and 21 obstructed cases. Significant differences were noted in all pressure flow study parameters (analysis of variance p <0.05). Linear discriminant analysis showed that area under the curve of detrusor pressure during voiding adjusted for voided volume was the most statistically discriminating parameter. Of the cases 86%, 36% and 57% were identically categorized by the traditional and area under the curve of detrusor pressure during voiding adjusted for voided volume parameter classifications in the unobstructed, equivocal and obstructed groups, respectively. The other pressure flow study parameters showed less satisfactory results.
Area under the curve of detrusor pressure during voiding adjusted for voided volume appears to be the most discriminating urodynamic parameter of female bladder outlet obstruction. Other studies are needed to test the reliability and validity of this new parameter.
通过压力流研究诊断女性膀胱出口梗阻可能存在困难，因为膀胱出口梗阻有多种定义、多个参数且没有标准的临界值。我们评估了压力流研究将女性分为无梗阻、可疑和梗阻组的能力。
在一项前瞻性研究中，85名有下尿路症状的女性接受了临床评估，包括体格检查、排尿性膀胱尿道造影、内镜检查、尿流率和排尿后残余尿量测量。15天后进行压力流研究。压力流研究参数包括最大尿流率、排尿后残余尿量、最大尿流率时的逼尿肌压力、最大尿流率时的膀胱压力、排尿期间逼尿肌压力曲线下面积以及根据排尿量调整后的排尿期间逼尿肌压力曲线下面积。在考虑临床评估后，2名泌尿科医生将患者分为3组，即无梗阻、可疑和梗阻组，作为传统分类。然后使用传统分类和压力流研究数据进行线性判别分析。
患者平均年龄为55岁（范围18至83岁）。根据传统分类，有36例无梗阻、28例可疑和21例梗阻病例。在所有压力流研究参数中均观察到显著差异（方差分析p<0.05）。线性判别分析表明，根据排尿量调整后的排尿期间逼尿肌压力曲线下面积是最具统计学判别力的参数。在无梗阻、可疑和梗阻组中，分别有86%、36%和57%的病例通过传统分类和根据排尿量调整后的排尿期间逼尿肌压力曲线下面积参数分类得到相同的分类。其他压力流研究参数的结果不太令人满意。
根据排尿量调整后的排尿期间逼尿肌压力曲线下面积似乎是女性膀胱出口梗阻最具判别力的尿动力学参数。需要其他研究来测试这一新参数的可靠性和有效性。
