Gowda Meghana, Danford Jill M, Hu Yan, Slaughter James C, Zimmerman Carl W, Ward Renée M
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Vanderbilt University, B-1100 Medical Center North, Nashville, TN 37232, USA.
Int Urogynecol J. 2013 Jul;24(7):1167-71. doi: 10.1007/s00192-012-1989-3. Epub 2012 Nov 17.
This study evaluated whether bladder trabeculations are associated with advanced prolapse, urinary urgency, or detrusor overactivity among women undergoing office cystoscopy. It is well established that bladder trabeculations are associated with bladder outlet obstruction (BOO) in men; however, the clinical significance of trabeculations in women is unclear. Whereas an analogous relationship has been proposed between prostatic obstruction in men and advanced pelvic organ prolapse (POP) in women, little data in the medical literature supports this theory.
A retrospective cohort study was conducted using Current Procedural Terminology (CPT) codes (52000, 52204) to identify all women who underwent office cystoscopy at our urogynecology center between January 2008 and May 2011. The 551 women identified were grouped by the presence or absence of bladder trabeculations. Multivariable logistic regression was used to estimate the association between trabeculations and the primary aim, increasing stage of prolapse, and the secondary aims: bladder outlet obstruction, detrusor overactivity, or urge urinary incontinence (UUI).
Of the 551 women meeting inclusion criteria, 86 had trabeculations. Controlling for age, the odds of bladder trabeculations were eightfold greater for women with stage IV POP when compared with women with stage 0 prolapse [odds ratio (OR) 8.2, 95% confidence interval (CI) 1.6-43.1]. The odds of bladder trabeculations were twofold greater for women with detrusor overactivity (OR 2.3, 95% CI 1.3-4.0) found on urodynamic study and also as reflected subjectively by answers to Pelvic Floor Distress Inventory (PFDI) item number 16 (OR 4.2, 95% CI 1.3-14.5).
In this study, bladder trabeculations were associated with stage IV prolapse in the anterior compartment as well as with detrusor overactivity and UUI.
本研究评估了在接受门诊膀胱镜检查的女性中，膀胱小梁形成是否与严重脱垂、尿急或逼尿肌过度活动相关。众所周知，膀胱小梁形成与男性膀胱出口梗阻（BOO）有关；然而，小梁形成在女性中的临床意义尚不清楚。尽管有人提出男性前列腺梗阻与女性严重盆腔器官脱垂（POP）之间存在类似关系，但医学文献中几乎没有数据支持这一理论。
采用当前程序术语（CPT）编码（52000、52204）进行一项回顾性队列研究，以确定2008年1月至2011年5月期间在我们的泌尿妇科中心接受门诊膀胱镜检查的所有女性。确定的551名女性按是否存在膀胱小梁形成进行分组。多变量逻辑回归用于估计小梁形成与主要目标（脱垂分期增加）以及次要目标（膀胱出口梗阻、逼尿肌过度活动或急迫性尿失禁（UUI））之间的关联。
在符合纳入标准的551名女性中，86名有膀胱小梁形成。在控制年龄的情况下，IV期POP女性出现膀胱小梁形成的几率比0期脱垂女性高8倍[比值比（OR）8.2，95%置信区间（CI）1.6 - 43.1]。尿动力学研究发现有逼尿肌过度活动的女性出现膀胱小梁形成的几率高2倍（OR 2.3，95%CI 1.3 - 4.0），盆底困扰量表（PFDI）第16项的主观回答也反映出这一点（OR 4.2，95%CI 1.3 - 14.5）。
在本研究中，膀胱小梁形成与前盆腔IV期脱垂以及逼尿肌过度活动和UUI相关。
