From the Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Obstet Gynecol. 2011 Sep;118(3):637-642. doi: 10.1097/AOG.0b013e318229e8dd.
To compare the diagnostic accuracy of two voiding trial methods to predict postoperative voiding dysfunction.
Women undergoing operations for urinary incontinence, prolapse, or both urinary incontinence and prolapse from November 2009 and March 2010 were randomized into one of two groups: retrograde or spontaneous. All patients underwent both techniques of voiding trials with randomization determining order.
Fifty women were randomized to 25 per group. Failure rates were 62% for retrograde and 84% for spontaneous. Women who failed both had 12.6±14.4 days of retention compared with 2.5±2.1 days for those who failed only one method (P=.004). The retrograde method had 94.4% sensitivity and 58.1% specificity to detect postoperative voiding dysfunction lasting at least 7 days compared with the spontaneous method with 100% sensitivity and 25.8% specificity. Positive and negative predictive values for the retrograde method were 56.7% and 94.7%, respectively, compared with the spontaneous method with 43.9% and 100%. Retrograde was preferred by patients (51.1% compared with 44.4%) regardless of randomization.
The retrograde method is more accurate in evaluating postoperative voiding dysfunction, although both tests had a low positive predictive value. A longer period of retention was seen with failure of both methods. Retrograde was preferred by patients and provides an efficient alternative to the spontaneous method of voiding trial.
ClinicalTrials.gov, www.clinicaltrials.gov, NCT01091844.
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比较两种排尿试验方法对预测术后排尿功能障碍的诊断准确性。
2009 年 11 月至 2010 年 3 月期间因尿失禁、脱垂或尿失禁合并脱垂而接受手术的女性患者被随机分为逆行组或自发组。所有患者均接受两种排尿试验，随机决定顺序。
50 名女性被随机分为每组 25 名。逆行组的失败率为 62%，自发组为 84%。两种方法均失败的女性留置时间为 12.6±14.4 天，而仅有一种方法失败的女性留置时间为 2.5±2.1 天（P=.004）。逆行法检测术后至少持续 7 天的排尿功能障碍的灵敏度为 94.4%，特异性为 58.1%，而自发法的灵敏度为 100%，特异性为 25.8%。逆行法的阳性预测值和阴性预测值分别为 56.7%和 94.7%，而自发法的阳性预测值和阴性预测值分别为 43.9%和 100%。无论随机分组如何，患者都更喜欢逆行法（51.1%比 44.4%）。
尽管两种试验的阳性预测值均较低，但逆行法在评估术后排尿功能障碍方面更为准确。两种方法均失败的患者留置时间较长。患者更喜欢逆行法，且逆行法为自发法排尿试验提供了一种有效的替代方法。
ClinicalTrials.gov，www.clinicaltrials.gov，NCT01091844。
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