Lovatsis Danny, Drutz Harold P, Wilson Don, Duggan Paul
University of Manitoba, Winnipeg, MB, Canada.
J Obstet Gynaecol Can. 2002 Apr;24(4):315-9. doi: 10.1016/s1701-2163(16)30624-7.
(1) To determine the proportion of Canadian gynaecologists who have urodynamic studies (UDS) readily available; (2) to assess the preoperative UDS utilization patterns of Canadian gynaecologists in various clinical scenarios of stress urinary incontinence (SUI).
A mail survey was sent to all 1266 obstetrician/gynaecologist members of the Society of Obstetricians and Gynaecologists of Canada (SOGC), as part of an international survey with the U.K., U.S.A., New Zealand, and Australia. Survey questions included geographic availability of UDS and specific types of urodynamics testing available. Utilization of urodynamics prior to anti-incontinence surgery was assessed in four clinical scenarios: (A) a history of uncomplicated primary stress urinary incontinence, (B) a history of mixed stress and urgency incontinence, (C) stress incontinence with a history of straining to void, and (D) recurrent stress incontinence.
Of the 1266 surveys mailed, 230 (18%) were returned. Forty-four of the respondents did not manage incontinent women. Of the 186 respondents who did, 27% reported a special interest or additional postgraduate training in urogynaecology, and 73% were general gynaecologists. UDS were available in the same centre or city to 79% of respondents. For uncomplicated primary stress incontinence, 47% would always obtain preoperative UDS, 42% would not, and 11% would only if UDS were readily available. For the total group of respondents, in scenario A 47% would always obtain preoperative UDS, 42% would not, and 11% would only if UDS were readily available. Among general gynaecologists, in scenario A, if UDS were available in their city or centre of practice, 54% would always obtain preoperative UDS, as compared to 5% by general gynaecologists who did not have UDS available in their city or centre of practice.
The data collected in this survey are compromised because of the low response rate. However, most (79%) of the respondents who manage women with urinary incontinence had access to urodynamics in the same centre or city. The utilization of urodynamics prior to surgical treatment of uncomplicated primary pure stress incontinence varies depending on the availability of such testing. An uncomplicated history of primary SUI and decreased availability of testing were two factors seen to have an effect of decreasing utilization of preoperative UDS. Hospital management did not always comply with SOGC guidelines for preoperative testing for SUI. Updating and dissemination of these guidelines is necessary to ensure "best" practice and highest quality of care for all women with SUI in Canada.
（1）确定能随时开展尿动力学检查（UDS）的加拿大妇科医生的比例；（2）评估加拿大妇科医生在压力性尿失禁（SUI）各种临床情况下术前UDS的使用模式。
作为与英国、美国、新西兰和澳大利亚联合开展的一项国际调查的一部分，向加拿大妇产科医师协会（SOGC）的所有1266名产科/妇科医生会员发送了邮件调查问卷。调查问题包括UDS在当地的可获得情况以及可进行的具体尿动力学检查类型。在四种临床情况下评估抗尿失禁手术前尿动力学的使用情况：（A）单纯原发性压力性尿失禁病史；（B）压力性与急迫性混合性尿失禁病史；（C）有排尿费力史的压力性尿失禁；（D）复发性压力性尿失禁。
在寄出的1266份调查问卷中，有230份（18%）被退回。44名受访者不负责管理尿失禁女性患者。在负责管理的186名受访者中，27%表示对女性盆底泌尿学有特殊兴趣或接受过额外的研究生培训，73%为普通妇科医生。79%的受访者所在的同一中心或城市可开展UDS检查。对于单纯原发性压力性尿失禁，47%的受访者总是会在术前进行UDS检查，42%不会，11%仅在UDS检查容易获得时才会进行。对于所有受访者，在情况A中，47%总是会在术前进行UDS检查，42%不会，11%仅在UDS检查容易获得时才会进行。在普通妇科医生中，在情况A中，如果其所在城市或执业中心可开展UDS检查，54%总是会在术前进行UDS检查，而所在城市或执业中心无法开展UDS检查的普通妇科医生这一比例为5%。
由于回复率较低，本次调查收集的数据存在缺陷。然而，大多数（79%）负责管理尿失禁女性患者的受访者所在的同一中心或城市可进行尿动力学检查。对于单纯原发性单纯性压力性尿失禁手术治疗前尿动力学的使用情况因检查的可获得性而异。原发性SUI病史单纯且检查可获得性降低是导致术前UDS使用减少的两个因素。医院管理并非总是符合SOGC关于SUI术前检查的指南。有必要更新并传播这些指南，以确保为加拿大所有SUI女性提供“最佳”实践和最高质量的护理。
