Department of Urogynaecology, St. Mary's Hospital, Imperial College NHS Trust, London, United Kingdom.
Eur J Obstet Gynecol Reprod Biol. 2013 Jul;169(2):408-11. doi: 10.1016/j.ejogrb.2013.05.027. Epub 2013 Jun 30.
To assess the sensitivity, specificity, positive and negative predictive value of cystoscopy and the clinical value of bladder biopsy in women with refractory overactive bladder (OAB) symptoms.
Prospective observational study carried out in a tertiary referral urogynaecology unit in London. Consecutive women with OAB resistant to pharmacotherapy who underwent cystoscopy, hydrodistention and bladder biopsy were studied. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of cystoscopy as well as histological findings for chronic cystitis were evaluated.
106 women aged 22-91 years were studied. Histopathology showed chronic cystitis in 94 women, follicular cystitis 3, acute and chronic cystitis in 2, transitional cell carcinoma in 6 and no abnormality in 1 woman. Trabeculations and increased vascularity were the most common cystoscopic findings, seen in 71% and 72% of women respectively. Haemorrhages on first filling and haemorrhages on refilling had specificities of 86.6% and 80% respectively for chronic cystitis. Their sensitivities were 9.8% and 13.1% respectively. Trabeculations and increased vascularity had sensitivities of 68.1% and 68.1% and their specificities were 11.6% and 4.5% respectively. Trabeculations, increased vascularity, haemorrhages on first filling and haemorrhages on refilling all had a PPV over 80% for chronic cystitis.
More than 90% of women with refractory OAB symptoms have chronic cystitis on histopathology. Cystoscopy alone is useful, but not always adequate to diagnose chronic cystitis. Antibiotic therapy in those women might be beneficial before starting anticholinergics. Larger randomised controlled trials are mandatory to confirm our hypothesis.
评估膀胱镜检查对难治性膀胱过度活动症（OAB）女性的敏感性、特异性、阳性预测值和阴性预测值，以及膀胱活检的临床价值。
在伦敦的一家三级转诊尿妇科单位进行的前瞻性观察性研究。对接受膀胱镜检查、水扩张和膀胱活检的难治性药物治疗 OAB 女性进行了研究。评估了膀胱镜检查的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），以及慢性膀胱炎的组织学发现。
研究了 106 名年龄在 22-91 岁的女性。组织病理学显示 94 名女性为慢性膀胱炎，3 名滤泡性膀胱炎，2 名急性和慢性膀胱炎，6 名移行细胞癌，1 名女性无异常。小梁形成和血管增多是最常见的膀胱镜下表现，分别见于 71%和 72%的女性。首次充盈时出血和再充盈时出血对慢性膀胱炎的特异性分别为 86.6%和 80%。其敏感性分别为 9.8%和 13.1%。小梁形成和血管增多的敏感性分别为 68.1%和 68.1%，特异性分别为 11.6%和 4.5%。小梁形成、血管增多、首次充盈时出血和再充盈时出血对慢性膀胱炎的阳性预测值均超过 80%。
超过 90%的难治性 OAB 症状女性在组织病理学上有慢性膀胱炎。单独使用膀胱镜检查是有用的，但并不总是足以诊断慢性膀胱炎。在开始使用抗胆碱能药物之前，对这些女性进行抗生素治疗可能是有益的。需要进行更大规模的随机对照试验来证实我们的假设。
