尿动力学检查对行压力性尿失禁手术的女性患者的临床诊断、治疗方案和结局的影响。
The effect of urodynamic testing on clinical diagnosis, treatment plan and outcomes in women undergoing stress urinary incontinence surgery.
机构信息
Department Urology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
出版信息
J Urol. 2013 Jan;189(1):204-9. doi: 10.1016/j.juro.2012.09.050. Epub 2012 Oct 8.
PURPOSE
We evaluated the influence of preoperative urodynamic studies on diagnoses, global treatment plans and outcomes in women treated with surgery for uncomplicated stress predominant urinary incontinence.
MATERIALS AND METHODS
We performed a secondary analysis from a multicenter, randomized trial of the value of preoperative urodynamic studies. Physicians provided diagnoses before and after urodynamic studies and global treatment plans, defined as proceeding with surgery, surgery type, surgical modification and nonoperative therapy. Treatment plan changes and surgical outcomes between office evaluation and office evaluation plus urodynamic studies were compared by the McNemar test.
RESULTS
Of 315 subjects randomized to urodynamic studies after office evaluation 294 had evaluable data. Urodynamic studies changed the office evaluation diagnoses in 167 women (56.8%), decreasing the diagnoses of overactive bladder-wet (41.6% to 25.2%, p <0.001), overactive bladder-dry (31.4% to 20.8%, p = 0.002) and intrinsic sphincter deficiency (19.4% to 12.6%, p = 0.003) but increasing the diagnosis of voiding dysfunction (2.2% to 11.9%, p <0.001). After urodynamic studies physicians canceled surgery in 4 of 294 women (1.4%), changed the incontinence procedure in 13 (4.4%) and planned to modify mid urethral sling tension (more or less obstructive) in 20 women (6.8%). Nonoperative treatment plans changed in 40 of 294 women (14%). Urodynamic study driven treatment plan changes were not associated with treatment success (OR 0.96, 95% CI 0.41, 2.25, p = 0.92) but they were associated with increased postoperative treatment for urge urinary incontinence (OR 3.23, 95% CI 1.46, 7.14, p = 0.004).
CONCLUSIONS
Urodynamic studies significantly changed clinical diagnoses but infrequently changed the global treatment plan or influenced surgeon decision to cancel, change or modify surgical plans. Global treatment plan changes were associated with increased treatment for postoperative urgency urinary incontinence.
目的
我们评估了术前尿动力学研究对单纯性压力性尿失禁女性手术治疗的诊断、总体治疗计划和结局的影响。
材料和方法
我们对一项术前尿动力学研究价值的多中心、随机试验进行了二次分析。医生在尿动力学研究前后提供了诊断，并制定了总体治疗计划，定义为继续手术、手术类型、手术修改和非手术治疗。通过 McNemar 检验比较术前评估与术前评估加尿动力学研究之间的治疗计划改变和手术结局。
结果
在 315 例接受尿动力学研究的随机患者中，294 例有可评估的数据。尿动力学研究改变了 167 例女性（56.8%）的门诊评估诊断，减少了过度活动膀胱湿（41.6%至 25.2%，p<0.001）、过度活动膀胱干（31.4%至 20.8%，p=0.002）和固有括约肌缺陷（19.4%至 12.6%，p=0.003）的诊断，但增加了排尿功能障碍（2.2%至 11.9%，p<0.001）的诊断。尿动力学研究后，294 例女性中有 4 例（1.4%）取消手术，13 例（4.4%）改变了尿失禁手术，20 例（6.8%）计划修改中尿道吊带张力（更具阻塞性）。294 例女性中有 40 例（14%）改变了非手术治疗计划。尿动力学研究驱动的治疗计划改变与治疗成功无关（OR 0.96，95%CI 0.41，2.25，p=0.92），但与术后急迫性尿失禁的治疗增加有关（OR 3.23，95%CI 1.46，7.14，p=0.004）。
结论
尿动力学研究显著改变了临床诊断，但很少改变总体治疗计划或影响外科医生取消、改变或修改手术计划的决定。总体治疗计划的改变与术后急迫性尿失禁的治疗增加有关。
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