Borazjani Ali, Tadesse Helina, Ayenachew Fekade, Goldman Howard B, Damaser Margot S, Wall L Lewis
Global Innovations for Reproductive Health & Life, Cleveland, OH, USA,
Int Urogynecol J. 2015 May;26(5):749-55. doi: 10.1007/s00192-014-2575-7. Epub 2014 Dec 5.
Most patients in regions where obstetric vesicovaginal fistulas (VVF) are endemic void using a squatting posture. Additionally, many patients continue to have lower urinary tract symptoms (LUTS) following fistula closure. We designed and validated a prototype platform that allows urodynamic studies to be performed in a squatting position and conducted a pilot study to assess uroflowmetry in this patient population.
Sixteen patients with persistent LUTS following fistula surgery were recruited. Posture measurements were taken in each patient's natural voiding posture on the ground and were then repeated using the platform. Nine patients with persistent urinary incontinence also underwent uroflowmetry. The data were compared with normal values in different nomograms. Paired t tests were used to determine significant differences in posture. One-way ANOVA was used to determine statistical significance between flow rate values.
Only the heel-to-heel distance (H-H) measure of posture was significantly increased on the platform compared with on the ground. The mean corrected Qmax was 0.89 ± 0.46. Flow rate values were significantly lower than mean normal flow rates obtained from the nomograms. In general, the patients' uroflowmetry patterns were similar to those indicative of impaired detrusor function.
A platform for conducting urodynamic studies in a squatting posture was successfully validated in the VVF patient population. The finding of increased H-H on the platform is expected, since the patient must accommodate a large funnel for urine collection. The pilot data suggest that patients with persistent urinary incontinence following VVF closure may also have significant voiding dysfunction.
在产科膀胱阴道瘘（VVF）流行地区，大多数患者采用蹲姿排尿。此外，许多患者在瘘管闭合后仍有下尿路症状（LUTS）。我们设计并验证了一个原型平台，该平台可使尿动力学研究在蹲姿下进行，并开展了一项试点研究以评估该患者群体的尿流率。
招募了16例瘘管手术后仍有持续性LUTS的患者。在地面上以每位患者自然排尿姿势进行体位测量，然后使用该平台重复测量。9例持续性尿失禁患者也接受了尿流率测定。将数据与不同列线图中的正常值进行比较。采用配对t检验确定体位的显著差异。采用单因素方差分析确定流速值之间的统计学显著性。
与在地面上相比，仅平台上的足跟到足跟距离（H-H）体位测量值显著增加。平均校正最大尿流率（Qmax）为0.89±0.46。流速值显著低于从列线图获得的平均正常流速。总体而言，患者的尿流率模式与提示逼尿肌功能受损的模式相似。
一个用于在蹲姿下进行尿动力学研究的平台在VVF患者群体中成功得到验证。平台上H-H增加这一发现在意料之中，因为患者必须适应一个大的尿液收集漏斗。试点数据表明，VVF闭合后持续性尿失禁的患者可能也存在明显的排尿功能障碍。
