Holroyd-Leduc Jayna M, Tannenbaum Cara, Thorpe Kevin E, Straus Sharon E
Division of Geriatrics, and Knowledge Translation Program, University of Calgary, Calgary, Alberta, Canada.
JAMA. 2008 Mar 26;299(12):1446-56. doi: 10.1001/jama.299.12.1446.
Urinary incontinence is a prevalent condition and treatment options can depend on what type of incontinence is present.
To systematically review the evidence about the most accurate way to determine the type of urinary incontinence during an office assessment.
A search of MEDLINE using Ovid (1966-July 2007) and EMBASE (1980-July 2007), and the bibliographies of retrieved articles to identify relevant studies. Search terms included urinary incontinence, diagnostic tests, medical history taking, physical examination, cough stress test, and urodynamics.
English-language articles were identified that addressed the office diagnosis of urinary incontinence in adults, in which data was not limited to case reports. Cohort studies of patients undergoing history, physical examination, and/or office procedures (excluding urodynamics) for diagnosing the type of urinary incontinence were included. Case-control studies were considered when there was insufficient data available from cohort studies. The accepted reference standard for categorization of incontinence type was diagnosis confirmed by an expert, urodynamic studies, or both.
Two investigators independently appraised study quality and extracted relevant data. Minimum inclusion criteria were completion of an appropriate reference standard in all patients and the ability to extract relevant data.
Forty articles were identified for inclusion. A random-effects model was used for quantitative synthesis. Minimal data was available for men. In women, simple questions modestly helped diagnose stress urinary incontinence (summary positive likelihood ratio [LR], 2.2; 95% confidence interval [CI], 1.6-3.2; summary negative LR, 0.39; 95% CI, 0.25-0.61) but are more helpful in diagnosing urge urinary incontinence (summary positive LR, 4.2; 95% CI, 2.3-7.6; summary negative LR, 0.48; 95% CI, 0.36-0.62). A positive bladder stress test may help diagnose stress urinary incontinence (summary LR, 3.1; 95% CI, 1.7-5.5); however, a negative test is not as useful (summary LR, 0.36; 95% CI, 0.21-0.60). A systematic assessment combining the history, physical examination, and results of bedside tests to establish a clinical diagnosis appears to be of modest value in diagnosing stress urinary incontinence (summary positive LR, 3.7; 95% CI, 2.6-5.2; summary negative LR, 0.20; 95% CI, 0.08-0.51). The systematic assessment is less helpful in diagnosing urge urinary incontinence (summary positive LR, 2.2; 95% CI, 0.55-8.7; summary negative LR, 0.63; 95% CI, 0.34-1.17).
The most helpful component for diagnosing urge urinary incontinence is a history of urine loss associated with urgency. A bladder stress test may be helpful for diagnosing stress urinary incontinence.
尿失禁是一种常见病症，治疗方案可能取决于所患尿失禁的类型。
系统回顾关于在门诊评估期间确定尿失禁类型的最准确方法的证据。
使用Ovid检索MEDLINE（1966年 - 2007年7月）和EMBASE（1980年 - 2007年7月），并查阅检索到的文章的参考文献以识别相关研究。检索词包括尿失禁、诊断测试、病史采集、体格检查、咳嗽压力试验和尿动力学。
纳入了针对成人尿失禁门诊诊断的英文文章，其中数据不限于病例报告。纳入了对患者进行病史、体格检查和/或门诊程序（不包括尿动力学）以诊断尿失禁类型的队列研究。当队列研究数据不足时考虑病例对照研究。尿失禁类型分类的公认参考标准是由专家确诊、尿动力学研究或两者兼而有之。
两名研究人员独立评估研究质量并提取相关数据。最低纳入标准是所有患者均完成适当的参考标准且能够提取相关数据。
确定40篇文章纳入研究。采用随机效应模型进行定量综合。男性可用数据极少。在女性中，简单问题对诊断压力性尿失禁有一定帮助（汇总阳性似然比[LR]，2.2；95%置信区间[CI]，1.6 - 3.2；汇总阴性LR，0.39；95%CI，0.25 - 0.61），但对诊断急迫性尿失禁更有帮助（汇总阳性LR，4.2；95%CI，2.3 - 7.6；汇总阴性LR，0.48；95%CI，0.36 - 0.62）。阳性膀胱压力试验可能有助于诊断压力性尿失禁（汇总LR，3.1；95%CI，1.7 - 5.5）；然而，阴性试验的作用不大（汇总LR，0.36；95%CI，0.21 - 0.60）。结合病史、体格检查和床边测试结果进行系统评估以建立临床诊断，在诊断压力性尿失禁方面似乎有一定价值（汇总阳性LR，3.7；95%CI，2.6 - 5.2；汇总阴性LR，0.20；95%CI，0.08 - 0.51）。系统评估对诊断急迫性尿失禁的帮助较小（汇总阳性LR，2.2；95%CI，0.55 - 8.7；汇总阴性LR，0.63；95%CI，0.34 - 1.17）。
诊断急迫性尿失禁最有用的因素是伴有尿急的漏尿病史。膀胱压力试验可能有助于诊断压力性尿失禁。
