Blanchard Kristie A, Wilson Woodie J, Winters J Christian
Department of Urology, Ochsner Clinic Foundation, New Orleans, LA.
Ochsner J. 2007 Spring;7(1):20-3.
The value of urodynamics (UDS) as a predictor of voiding dysfunction after pubovaginal sling is controversial. We sought to determine whether individual urodynamic parameters or a "Voiding Quality Index" (VQI) can predict prolonged catheter time after sling.
Individual voiding parameters for the 75 patients who had preoperative urodynamics included maximum detrusor pressure (Pdet), voiding time (VT), maximum uroflow (Qmax), post-void residual (PVR), and abdominal straining. Each parameter was scored 1 if normal and 0 if abnormal; these urodynamic scores were added to calculate the VQI (range 0-5). Each patient had a suprapubic catheter and maintained a voiding diary. Individual voiding parameters and the VQI were compared statistically between groups who required a catheter for more than 14 days and those who did not. Informed consent was obtained from all patients and the study was conducted with Ochsner Institutional Review Board approval.
Average catheter time for the 66 patients who completed the study was 11.1 days. Fifty patients voided within 14 days and were defined as being in the non-retention group (NR). Sixteen patients were catheter dependent at 14 days and were considered in the retention group (R). When each voiding parameter was individually analyzed between groups with respect to catheter time, the mean values in each group were not significantly different and offered no predictive value. When the VQI was analyzed between groups, the VQI was significantly lower for patients developing voiding difficulty (VQI-R = 3.81) than those who did not (VQI-NR = 2.31) p = .001.
No single urodynamic voiding parameter accurately predicts prolonged catheter time following sling. A combination of voiding parameters, the "Voiding Quality Index," may predict patients at risk for prolonged catheter time following sling.
尿动力学检查（UDS）作为耻骨后阴道悬吊术后排尿功能障碍预测指标的价值存在争议。我们试图确定个体尿动力学参数或“排尿质量指数”（VQI）是否能预测悬吊术后导尿管留置时间延长。
对75例术前行尿动力学检查的患者的个体排尿参数进行评估，包括最大逼尿肌压力（Pdet）、排尿时间（VT）、最大尿流率（Qmax）、残余尿量（PVR）和腹压。若参数正常则评分为1，异常则评分为0；将这些尿动力学评分相加计算VQI（范围为0 - 5）。每位患者均留置耻骨上导尿管并记录排尿日记。对导尿管留置时间超过14天的患者组和未超过14天的患者组的个体排尿参数及VQI进行统计学比较。所有患者均签署知情同意书，本研究经奥施纳机构审查委员会批准。
完成研究的66例患者的平均导尿管留置时间为11.1天。50例患者在14天内恢复自主排尿，被定义为非潴留组（NR）。16例患者在14天时仍依赖导尿管，被纳入潴留组（R）。当分别分析两组间各排尿参数与导尿管留置时间的关系时，每组的平均值无显著差异，无预测价值。当分析两组间的VQI时，出现排尿困难的患者（VQI - R = 3.81）的VQI显著低于未出现排尿困难的患者（VQI - NR = 2.31），p = 0.001。
没有单一的尿动力学排尿参数能准确预测悬吊术后导尿管留置时间延长。综合排尿参数的“排尿质量指数 ”可能预测悬吊术后导尿管留置时间延长风险的患者。
