Bael An M, Lax Hildegard, Hirche Herbert, Gäbel Elisabeth, Winkler Pauline, Hellström Anna-Lena, van Zon Roelie, Janhsen Ellen, Güntek Sophie, Renson Catherine, van Gool Jan D
Department of Paediatric Nephrology, University Hospital Antwerp, Belgium.
BJU Int. 2007 Sep;100(3):651-6. doi: 10.1111/j.1464-410X.2007.06933.x. Epub 2007 May 4.
To determine the congruence between self-reported and objective data on incontinence, voided volume (VV) and voiding frequency (VF), in a prospective study of treatment of functional urinary incontinence (UI) due to urge syndrome or dysfunctional voiding in children.
In all, 202 children, enrolled in the European Bladder Dysfunction Study (EBDS), provided self-reported data on UI, VV and VF, before and after treatment, with validated questionnaires and 72-h voiding diaries. Objective data were obtained with uroflowmetry and a 12-h pad test, also before and after treatment. Questionnaires and diaries were checked and scored by a urotherapist, at scheduled office visits that were combined with uroflowmetry.
At entry, parents under-reported UI on the questionnaires in 45% of cases, compared with the urotherapist's scores, and the 12-h pad test sensitivity for UI was only 64% (95% confidence interval 55-73%). The voiding diaries had inconsistent entries on UI and on VV. VF was overestimated in the questionnaires and underestimated in the diaries, compared with the urotherapist's scores. A VF of >7/day decreased significantly after EBDS treatment, but with no correlation with treatment outcome. The mean VV increased significantly after treatment for UI, also with no correlation with treatment outcome.
Voiding diaries and questionnaires are useful tools for charting individual treatment and for screening, but they are ill-suited to documenting outcome variables in urge syndrome or dysfunctional voiding, because of over- and under-reporting. VV and VF lack specificity as outcome variables in children with urge syndrome or dysfunctional voiding. The 12-h pad test is not sensitive enough to complement self-reported symptoms of UI in children with urge syndrome or dysfunctional voiding. Clinical studies on UI rely on complaints and self-reported symptoms, but in children the reporting should be supervised by a trained urotherapist, to provide the necessary checks and balances.
在一项针对儿童急迫性综合征或功能性排尿障碍所致功能性尿失禁（UI）治疗的前瞻性研究中，确定自我报告的尿失禁、排尿量（VV）和排尿频率（VF）数据与客观数据之间的一致性。
共有202名儿童参与欧洲膀胱功能障碍研究（EBDS），在治疗前后通过经过验证的问卷和72小时排尿日记提供关于UI、VV和VF的自我报告数据。治疗前后还通过尿流率测定和12小时护垫试验获取客观数据。问卷和日记由一名尿疗师在与尿流率测定相结合的预定门诊就诊时进行检查和评分。
在入组时，与尿疗师的评分相比，45%的病例中家长在问卷上对UI的报告不足，12小时护垫试验对UI的敏感性仅为64%（95%置信区间55 - 73%）。排尿日记中关于UI和VV的记录不一致。与尿疗师的评分相比，问卷中VF被高估，而日记中VF被低估。EBDS治疗后，VF>7次/天显著下降，但与治疗结果无关。UI治疗后平均VV显著增加，也与治疗结果无关。
排尿日记和问卷是记录个体治疗情况及进行筛查的有用工具，但由于报告过多或过少，它们不适用于记录急迫性综合征或功能性排尿障碍的结果变量。在患有急迫性综合征或功能性排尿障碍的儿童中，VV和VF作为结果变量缺乏特异性。12小时护垫试验对于补充患有急迫性综合征或功能性排尿障碍儿童自我报告的UI症状来说不够敏感。关于UI的临床研究依赖于主诉和自我报告的症状，但在儿童中，报告应由训练有素的尿疗师监督，以提供必要的制衡。
