Espuña-Pons Montserrat, Dilla Tatiana, Castro David, Carbonell Cristina, Casariego Joaquín, Puig-Clota Montserrat
Institut Clínic de Ginecología, Obstetricia i Neonatología, Hospital Clínic, Barcelona University, Barcelona, Spain.
Neurourol Urodyn. 2007;26(6):836-41. doi: 10.1002/nau.20379.
Presently, there is no simple, universally accepted instrument for the initial diagnosis of urinary incontinence (UI), which is why physicians find it so difficult to integrate the diagnosis into their daily clinical practice. The objective of this study is to analyze the true value of the ICIQ-UI SF questionnaire (ICIQ), the stress test, and the combination of both for the diagnosis as to the type of UI.
Cross-sectional study performed in 116 women consulting for UI symptoms in two specialized health care centers. The subjects completed the ICIQ and underwent a stress test and urodynamic testing which was used for the reference diagnosis. Sensitivity, specificity, positive and negative predictive values, and the statistical "likelihood ratio (LR)" were assessed.
According to the ICIQ, 45 women (38.8%) suffered from Stress UI (SUI); 19 (16.4%), Urgency UI (UUI), and 49 (42.2%), Mixed UI (MUI). According to the stress test, 75 (64.7%) presented SUI. According to the combination of both tests, the diagnosis was SUI in 35 (30.2%), UUI in 17 (14.7%), and MUI in 37 (31.9%). Regarding urodynamic testing, observations were as follows: USI in 45 subjects (38.8%), detrusor overactivity (DO) in 25 (21.6%), and combination of both (MUI) in 30 (25.9%). The combination of ICIQ-UI SF plus stress test showed good specificity and negative predictive value, and the best LR coefficients obtained were: 3.11 (USI); 6.64 (UUI); 2.64 (MUI), and 3.77 ("all" SUI).
The combined use of the ICIQ plus stress test will aid in characterizing the type of UI at a basic health care level, favoring the prescription of the most appropriate treatment for each case.
目前，尚无一种简单且被普遍接受的用于尿失禁（UI）初始诊断的工具，这就是医生们发现将该诊断纳入日常临床实践如此困难的原因。本研究的目的是分析国际尿失禁咨询问卷简表（ICIQ）、压力试验以及两者结合对于尿失禁类型诊断的真实价值。
在两个专业医疗保健中心对116名因尿失禁症状前来咨询的女性进行横断面研究。研究对象完成ICIQ问卷，并接受压力试验和尿动力学检测，后者用于参考诊断。评估了敏感性、特异性、阳性和阴性预测值以及统计学“似然比（LR）”。
根据ICIQ问卷，45名女性（38.8%）患有压力性尿失禁（SUI）；19名（16.4%）患有急迫性尿失禁（UUI），49名（42.2%）患有混合性尿失禁（MUI）。根据压力试验，75名（64.7%）表现为SUI。根据两种检测方法的结合，诊断结果为SUI的有35名（30.2%），UUI的有17名（14.7%），MUI的有37名（31.9%）。关于尿动力学检测，观察结果如下：45名受试者（38.8%）为USI，25名（21.6%）为逼尿肌过度活动（DO），30名（25.9%）为两者皆有（MUI）。ICIQ-UI SF问卷加压力试验的结合显示出良好的特异性和阴性预测值，获得的最佳似然比系数如下：3.11（USI）；6.64（UUI）；2.64（MUI），以及3.77（“所有”SUI）。
ICIQ问卷与压力试验的联合使用将有助于在基层医疗保健水平上明确尿失禁的类型，有利于为每个病例开出最合适的治疗方案。
