Trutnovsky Gerda, Ulrich Daniela, Rojas Rodrigo Guzman, Mann Kristy, Aigmueller Thomas, Dietz Hans P
Sydney Medical School Nepean, Obstetrics and Gynaecology, University of Sydney, Sydney, NSW, 2006, Australia,
Int Urogynecol J. 2014 Jul;25(7):947-51. doi: 10.1007/s00192-014-2337-6. Epub 2014 Feb 11.
Patient reported measures are important for the evaluation of symptom-specific bother and the distinction between different types of urinary incontinence. The aim of the study was to assess the validity of physician administered visual analogue scales (VAS) for the bother from stress urinary incontinence (SUI) and urge urinary incontinence (UUI).
In this prospective cohort study based at a tertiary urogynecological unit, women attending for investigation of lower urinary tract symptoms (n = 504) were asked to indicate their subjective bother from SUI and UUI on a 10-cm VAS. Clinical assessment, including multichannel urodynamic testing and 4D translabial ultrasound was performed for clinical diagnosis. Linear regression was used to model the average increase in VAS bother score of SUI and UUI for each explanatory variable.
74 % (n = 375) reported symptoms of SUI, with mean bother of 5.7 out of 10 (SD 2.8), and 73 % (n = 370) symptoms of UUI, with a mean bother of 6.5 out of 10 (SD 2.6). Bother from UUI was positively associated with the symptoms of nocturia (p < 0.0001) and frequency (p = 0.002), and the urodynamic findings of detrusor overactivity (p < 0.0001). Bother from SUI was positively related to the urodynamic diagnosis of USI (p < 0.0001) and a low abdominal leak point pressure (ALPP) (p = 0.002), as well as to the ultrasound findings of cystourethrocele (p < 0.0001) and funnelling (p = 0.04). All univariate associations remained highly significant on multivariate analysis, controlling for age, BMI, parity, previous incontinence/prolapse surgery and previous hysterectomy.
Physician-administered VAS are a valid, reliable and practicable tool to measure bother related to SUI and UUI.
患者报告的测量指标对于评估特定症状的困扰程度以及区分不同类型的尿失禁至关重要。本研究的目的是评估医生使用的视觉模拟量表（VAS）在评估压力性尿失禁（SUI）和急迫性尿失禁（UUI）所致困扰方面的有效性。
在一家三级泌尿妇科单位进行的这项前瞻性队列研究中，要求前来调查下尿路症状的女性（n = 504）在10厘米的VAS上指出她们因SUI和UUI产生的主观困扰程度。进行了包括多通道尿动力学检测和4D经阴唇超声检查在内的临床评估以进行临床诊断。使用线性回归对每个解释变量的SUI和UUI的VAS困扰评分的平均增加进行建模。
74%（n = 375）报告有SUI症状，平均困扰程度为10分中的5.7分（标准差2.8），73%（n = 370）有UUI症状，平均困扰程度为10分中的6.5分（标准差2.6）。UUI所致困扰与夜尿症症状（p < 0.0001）、尿频（p = 0.002）以及逼尿肌过度活动的尿动力学结果（p < 0.0001）呈正相关。SUI所致困扰与USI的尿动力学诊断（p < 0.0001）、低腹压漏尿点压力（ALPP）（p = 0.002）以及膀胱尿道膨出（p < 0.0001）和漏斗形成（p = 0.04）的超声检查结果呈正相关。在多变量分析中，在控制了年龄、体重指数、产次、既往尿失禁/脱垂手术以及既往子宫切除术的情况下，所有单变量关联仍然高度显著。
医生使用的VAS是测量与SUI和UUI相关困扰的有效、可靠且实用的工具。
