Lippmann Quinn K, Diwadkar Gouri B, Zhou Hui, Menefee Shawn A
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, CA; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Reproductive Medicine, University of California, San Diego, School of Medicine, La Jolla, CA.
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, CA.
Am J Obstet Gynecol. 2015 Nov;213(5):724.e1-6. doi: 10.1016/j.ajog.2015.06.062. Epub 2015 Jul 8.
We examined trends in overall and preoperative urodynamics utilization among women with stress urinary incontinence (SUI) to determine if practice patterns changed following publication of a 2012 randomized trial questioning the value of preoperative urodynamics in patients with uncomplicated SUI.
We collected electronic medical record data on the number of female patient visits to Kaiser Permanente Southern California urology and urogynecology clinics with stress or mixed incontinence, urodynamic studies (UDS) performed, surgeries performed for stress incontinence, and the demographic and clinical characteristics of these patients during 2 discrete time periods before and after a potentially practice-changing publication. We used χ(2) tests and t tests as appropriate. A multivariate logistic regression model was used to estimate the odds of urodynamics performed during January 2013 through June 2014 (study period 2) compared to urodynamics performed during July 2010 through December 2011 (study period 1) after adjustment for demographic and clinical characteristics.
In all, 33,775 women were diagnosed as having SUI or mixed urinary incontinence during study period 1 and 37,238 women were diagnosed with these conditions during study period 2. Among these women 12.8% underwent UDS in study period 1 compared to 8.4% in study period 2 (P < .01). The rate of UDS per patient visit decreased 27.0% between the 2 time periods (P < .01). In women undergoing surgery for stress incontinence, urodynamics were performed 56.5% of the time in study period 1 and 46.5% of the time in study period 2. After controlling for demographic, pelvic organ prolapse, and other bladder diagnoses, the odds of urodynamics performed in study period 2 was 0.54 times the odds of urodynamics performed in study period 1 (95% confidence interval, 0.52-0.57). Among women with only the diagnosis of stress incontinence, 1.78% underwent urodynamics in study period 1 compared with 0.84% in study period 2 (P < .01). Preoperative urodynamics decreased from 39% in study period 1 to 20% in study period 2 (P < .01).
Significantly fewer UDS are being performed overall and prior to stress incontinence surgery in this population. This change may be due to recent studies suggesting low utility of urodynamics in patients with uncomplicated, stress-dominant incontinence.
我们研究了压力性尿失禁（SUI）女性患者总体及术前尿动力学检查的使用趋势，以确定在2012年一项随机试验发表后，实践模式是否发生了改变，该试验对单纯性SUI患者术前尿动力学检查的价值提出了质疑。
我们收集了南加州凯撒医疗集团泌尿外科和女性盆底医学与重建外科诊所女性患者就诊的数据，这些患者患有压力性或混合性尿失禁，接受了尿动力学检查（UDS），因压力性尿失禁接受了手术，以及在一项可能改变实践的出版物发表前后两个不同时间段内这些患者的人口统计学和临床特征。我们在适当的时候使用了χ²检验和t检验。采用多因素逻辑回归模型，在对人口统计学和临床特征进行调整后，估计2013年1月至2014年6月（研究期2）期间进行尿动力学检查的几率与2010年7月至2011年12月（研究期1）期间进行尿动力学检查的几率之比。
在研究期1，共有33775名女性被诊断为SUI或混合性尿失禁，在研究期2，有37238名女性被诊断为这些疾病。在这些女性中，研究期1有12.8%接受了UDS，而研究期2为8.4%（P < 0.01）。两个时间段之间，每次患者就诊的UDS使用率下降了27.0%（P < 0.01）。在因压力性尿失禁接受手术的女性中，研究期1进行尿动力学检查的比例为56.5%，研究期2为46.5%。在控制了人口统计学、盆腔器官脱垂和其他膀胱诊断因素后，研究期2进行尿动力学检查的几率是研究期1的0.54倍（95%置信区间，0.52 - 0.57）。在仅诊断为压力性尿失禁的女性中，研究期1有1.78%接受了尿动力学检查，而研究期2为0.84%（P < 0.01）。术前尿动力学检查从研究期1的39%降至研究期2的20%（P < 0.01）。
在这一人群中，总体及压力性尿失禁手术前进行的尿动力学检查显著减少。这种变化可能是由于最近的研究表明，尿动力学检查在单纯性、以压力性为主的尿失禁患者中效用较低。
