Pizzoferrato Anne-Cécile, Fauconnier Arnaud, Fritel Xavier, Bader Georges, Dompeyre Philippe
Department of Gynaecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France.
Research unit EA7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Versailles St-Quentin University, Montigny-le-Bretonneux, France.
Int Neurourol J. 2017 Jun;21(2):121-127. doi: 10.5213/inj.1732686.343. Epub 2017 Jun 21.
Maintaining urinary continence at stress requires a competent urethral sphincter and good suburethral support. Sphincter competence is estimated by measuring the maximal urethral closure pressure at rest. We aimed to study the value of a new urodynamic measure, the urethral closure pressure at stress (s-UCP), in the diagnosis and severity of female stress urinary incontinence (SUI).
A total of 400 women without neurological disorders were included in this observational study. SUI was diagnosed using the International Continence Society definition, and severity was assessed using a validated French questionnaire, the . The perineal examination consisted of rating the strength of the levator ani muscle (0-5) and an assessment of bladder neck mobility using point Aa (cm). The urodynamic parameters were maximal urethral closure pressure at rest, s-UCP, Valsalva leak point pressure (cm HO), and pressure transmission ratio (%).
Of the women, 358 (89.5%) were diagnosed with SUI. The risk of SUI significantly increased as s-UCP decreased (odds ratio [OR], 0.92; 95% confidence interval, 0.88-0.98). The discriminative value of the measure was good for the diagnosis of SUI (area under curve>0.80). s-UCP values less than or equal to 20 cm HO had a sensitivity of 73.1% and a specificity of 93.0% for predicting SUI. The association between s-UCP and SUI severity was also significant.
s-UCP is the most discriminative measure that has been identified for the diagnosis of SUI. It is strongly inversely correlated with the severity of SUI. It appears to be a specific SUI biomarker reflecting both urethral sphincter competence and urethral support.
在压力状态下维持尿失禁需要一个功能正常的尿道括约肌和良好的尿道下支持。通过测量静息时的最大尿道闭合压来评估括约肌功能。我们旨在研究一种新的尿动力学指标——压力状态下的尿道闭合压（s-UCP）在女性压力性尿失禁（SUI）诊断及严重程度评估中的价值。
本观察性研究共纳入400名无神经系统疾病的女性。采用国际尿控协会的定义诊断SUI，并使用经过验证的法国问卷评估严重程度。会阴检查包括对肛提肌力量进行评分（0-5分）以及使用Aa点（厘米）评估膀胱颈活动度。尿动力学参数包括静息时的最大尿道闭合压、s-UCP、瓦尔萨尔瓦漏尿点压力（厘米水柱）和压力传递率（%）。
这些女性中，358例（89.5%）被诊断为SUI。随着s-UCP降低，SUI的风险显著增加（优势比[OR]，0.92；95%置信区间，0.88-0.98）。该指标对SUI诊断的判别价值良好（曲线下面积>0.80）。s-UCP值小于或等于20厘米水柱对预测SUI的敏感性为73.1%，特异性为93.0%。s-UCP与SUI严重程度之间的关联也很显著。
s-UCP是已确定的用于诊断SUI的最具判别力的指标。它与SUI的严重程度呈强烈负相关。它似乎是一种反映尿道括约肌功能和尿道支持的特异性SUI生物标志物。
