前间隙下移：评估女性尿失禁患者尿道活动过度的一项新指标。

Serdinšek Tamara, But Igor

Department for General Gynaecology and Urogynaecology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia.

Int J Urol. 2017 Jul;24(7):548-552. doi: 10.1111/iju.13370. Epub 2017 May 26.

OBJECTIVES

To introduce a new, simple, non-invasive test to quantify urethral hypermobility.

METHODS

We reviewed data of women with urinary incontinence who were examined at the Department for General Gynaecology and Urogynaecology, Clinic for Gynaecology and Perinatology, Maribor, Slovenia, between October 2010 and March 2014. Patients' age, diagnosis, results of the Q-tip test and Pelvic Organ Prolapse Quantification measurements were collected. In addition, a new parameter was defined as anterior compartment descent, a midline distance between the external urethral meatus and maximum descent of the anterior vaginal wall when performed the Valsalva maneuver. Statistical analysis was performed with spss software using the Mann-Whitney test, correlation, regression and receiver operating characteristic curve analysis. The analysis was also carried out separately for patients with anterior compartment prolapse stage 0 or I.

RESULTS

A total of 472 women were included, 323 of them with anterior compartment prolapse stage 0 or I. Women with urethral hypermobility had significantly higher anterior compartment descent values than patients without urethral hypermobility (3.7 cm vs 2.6 cm, P < 0.001). A moderate correlation was found between anterior compartment descent and the Q-tip test (Spearman's rho = 0.55, P < 0.001). Age and anterior compartment descent were identified as independent variables for the presence of urethral hypermobility. When the cut-off value is set at 3.5 cm, anterior compartment descent represents a test for urethral hypermobility assessment with sensitivity of 65.2%, specificity of 88.6%, positive predictive value of 97.0% and negative predictive value of 30.7%. Anterior compartment descent values were also significantly higher in patients with anterior compartment prolapse stage 0 or I (3.4 ± 0.7 cm vs 2.6 ± 0.7 cm, P < 0.001).

CONCLUSIONS

The anterior compartment descent could be a valuable tool for the assessment of urethral hypermobility. Further effort should be directed into the standardization of the technique, determination of the normal range of anterior compartment descent, and its intra- and interobserver reliability.

目的

介绍一种新的、简单的、非侵入性的测试方法来量化尿道活动过度。

方法

我们回顾了2010年10月至2014年3月期间在斯洛文尼亚马里博尔妇科与围产学诊所普通妇科和泌尿妇科接受检查的尿失禁女性的数据。收集了患者的年龄、诊断、棉签试验结果和盆腔器官脱垂定量测量结果。此外，定义了一个新参数为前盆腔下降，即进行瓦尔萨尔瓦动作时尿道外口与阴道前壁最大下降点之间的中线距离。使用SPSS软件进行统计分析，采用曼-惠特尼检验、相关性分析、回归分析和受试者工作特征曲线分析。分析也分别针对前盆腔脱垂0期或I期的患者进行。

结果

共纳入472名女性，其中323名处于前盆腔脱垂0期或I期。尿道活动过度的女性前盆腔下降值显著高于无尿道活动过度的患者（3.7厘米对2.6厘米，P<0.001）。在前盆腔下降与棉签试验之间发现了中度相关性（斯皮尔曼相关系数=0.55，P<0.001）。年龄和前盆腔下降被确定为尿道活动过度存在的独立变量。当临界值设定为3.5厘米时，前盆腔下降代表一种用于评估尿道活动过度的测试，其灵敏度为65.2%，特异性为88.6%，阳性预测值为97.0%，阴性预测值为30.7%。前盆腔脱垂0期或I期的患者前盆腔下降值也显著更高（3.4±o.7厘米对2.6±0.7厘米，P<0.001）。