Gravina Giovanni Luca, Costa Alessia Mariagrazia, Galatioto Giuseppe Paradiso, Ronchi Piero, Tubaro Andrea, Vicentini Carlo
Department of Surgery, G. Mazzini Hospital, Teramo-University of L'Aquila, L'Aquila, Italy.
J Urol. 2007 Sep;178(3 Pt 1):959-63; discussion 963-4. doi: 10.1016/j.juro.2007.05.057. Epub 2007 Jul 16.
We estimated the prevalence of urodynamic obstruction in women with stress urinary incontinence and determined which clinical indicator (nonintubated uroflowmetry or urinary symptoms) better predicts urodynamic obstruction.
From December 2004 to June 2005, 101 women with urodynamic stress urinary incontinence were enrolled. Adjunctive lower urinary tract symptoms were also observed. Of 101 women with stress urinary incontinence 27 had abnormal and 74 had normal nonintubated uroflowmetry. Normal nonintubated uroflowmetry was defined as a bell-shaped curve with maximum flow more than 15 ml per second and post-void residual urine less than 50 ml. Urodynamic obstruction was diagnosed based on maximum urine flow less than 12 ml per second and maximum detrusor pressure at maximum flow more than 25 cm H(2)O.
In our stress urinary incontinence population the prevalence of urodynamic obstruction was 15.7%. In urodynamically obstructed women storage symptoms were most common (56.3%), while voiding and post-micturition symptoms were less common (31.3% and 6%, respectively). A good correlation between abnormal nonintubated uroflowmetry and urodynamic obstruction (phi = 0.718, p <0.0001) was found. lower urinary tract symptoms correlated weakly with urodynamic obstruction. The diagnostic performance of abnormal nonintubated uroflowmetry for predicting urodynamic obstruction showed that it had relatively low positive predictive value (51.8%) with high negative predictive value (97.3%), sensitivity (87.5%) and specificity (84.1%). The diagnostic performance of lower urinary tract symptoms was weak.
Our study confirms the coexistence of obstruction and stress urinary incontinence. In this population abnormal nonintubated uroflowmetry cannot always confirm the presence of urodynamic obstruction and complete urodynamic study might be indicated. Conversely normal nonintubated uroflowmetry seems to accurately predict normal urodynamic study and might render the execution of this test not essential. Symptoms represent a poor clinical indicator of voiding disorder.
我们评估了压力性尿失禁女性患者中尿动力学梗阻的患病率，并确定哪种临床指标（非插管尿流率测定或尿路症状）能更好地预测尿动力学梗阻。
2004年12月至2005年6月，纳入101例压力性尿失禁的女性患者。同时观察相关下尿路症状。101例压力性尿失禁女性患者中，27例非插管尿流率测定异常，74例正常。正常非插管尿流率测定定义为呈钟形曲线，最大尿流率大于每秒15毫升，排尿后残余尿量小于50毫升。根据最大尿流率小于每秒12毫升以及最大尿流率时最大逼尿肌压力大于25厘米水柱诊断尿动力学梗阻。
在我们的压力性尿失禁患者群体中，尿动力学梗阻的患病率为15.7%。在尿动力学梗阻的女性患者中，储尿期症状最为常见（56.3%），而排尿期和排尿后症状较少见（分别为31.3%和6%）。发现非插管尿流率测定异常与尿动力学梗阻之间存在良好相关性（phi = 0.718，p <0.0001）。下尿路症状与尿动力学梗阻的相关性较弱。非插管尿流率测定异常对预测尿动力学梗阻的诊断性能显示，其阳性预测值相对较低（51.8%），但阴性预测值较高（97.3%），敏感性（87.5%）和特异性（84.1%）。下尿路症状的诊断性能较弱。
我们的研究证实了梗阻与压力性尿失禁并存。在该群体中，非插管尿流率测定异常并不总能证实存在尿动力学梗阻，可能需要进行完整的尿动力学检查。相反，正常的非插管尿流率测定似乎能准确预测正常的尿动力学检查结果，可能使该项检查并非必需。症状是排尿障碍较差的临床指标。
