Jung Jae Hyun, Cho Sung Yong, Yoo Changwon, Oh Seung-June
Department of Urology, Seoul National University Hospital, Seoul, South Korea.
Department of Urology, SMG-SNU Boramae Medical Center, Seoul, South Korea.
Urology. 2014 Sep;84(3):515-9. doi: 10.1016/j.urology.2014.05.015.
To establish a cystoscopic grading system for trabeculation of neurogenic bladders.
A total of 140 neurogenic bladder patients who had undergone both fluoroscopic urodynamic study and cystoscopic examination were retrospectively reviewed. Cystoscopic images were categorized into 4 grades according to the formation of the muscle bundle layer and height-to-width ratio of the muscle bundle: 0 (none), 1 (mild), 2 (moderate), and 3 (severe). Test-retest reliability and interobserver reliability were assessed. Cystoscopic grade of the trabeculated bladder was correlated with urodynamic results and the fluoroscopic grades of trabeculation.
The test-retest reliability showed almost perfect agreement with all levels of Cronbach alpha ranging from 0.925 to 0.970. The intraclass correlation coefficient was 0.986, indicative of an almost perfect level of interobserver reliability. The grading system showed clinical significance by correlation with urodynamic parameters (Qmax, P value = .016; postvoid residual, P value <.001; bladder outlet obstruction index, P value = .002). Cystoscopic grades correlated moderately well with fluoroscopic grades, showing comparable clinical significance with fluoroscopic grades.
Our results showed that this novel cystoscopic classification of bladder trabeculation was highly reliable.
建立神经源性膀胱小梁形成的膀胱镜分级系统。
回顾性分析140例接受了荧光透视尿动力学检查和膀胱镜检查的神经源性膀胱患者。根据肌束层的形成及肌束高宽比，将膀胱镜图像分为4级：0级（无）、1级（轻度）、2级（中度）和3级（重度）。评估重测信度和观察者间信度。将小梁化膀胱的膀胱镜分级与尿动力学结果及荧光透视小梁分级进行相关性分析。
重测信度显示，Cronbach α系数在0.925至0.970之间，表明各水平间几乎完全一致。组内相关系数为0.986，表明观察者间信度几乎达到完美水平。该分级系统与尿动力学参数（最大尿流率，P值 = 0.016；残余尿量，P值 < 0.001；膀胱出口梗阻指数，P值 = 0.002）相关，具有临床意义。膀胱镜分级与荧光透视分级中度相关，显示出与荧光透视分级相当的临床意义。
我们的结果表明，这种新型的膀胱小梁膀胱镜分类高度可靠。
