Park Kyung Kgi, Kim Sung Dae, Huh Jung-Sik, Kim Young-Joo
Department of Urology, Jeju National University School of Medicine, Jeju, Korea.
Int Neurourol J. 2017 Jun;21(2):139-142. doi: 10.5213/inj.1732710.355. Epub 2017 Jun 21.
Recently, intrinsic sphincter deficiency (ISD) has been identified as one important factor in the outcome of stress urinary incontinence (SUI) related surgery. Clinical factors that can predict ISD are uncommon. The aim of this study was to determine predictive clinical factors for ISD in female patients with SUI.
The patients were classified into 3 groups according to the value of Valsalva leak point pressure (VLPP)>90 cm HO (anatomical incontinence, AI), between 61 and 90 cm HO (equivocal, EV), and <60 cm HO (ISD). All groups underwent a full examination, history evaluation, physical examination, uroflowmetry, and complete urodynamic study. Univariate analysis was performed by chi-square or t-test for categorical variables, respectively. A multivariate study was performed by Pearson correlation analysis in order to get clinical predictors of VLPP<60 cm HO. Statistical significance was set at P<0.05.
There were 3 groups with a total of 189 patients: 56 patients (AI, 29.7%), 64 patients (EV, 33.8%), and 69 patients (ISD, 36.5%). The univariate analysis revealed a significant difference associated with maximal urethral closing pressure (P=0.03) and Stamey classification (P=0.006) between ISD and AI. The more severe the urinary symptom grade, the higher the frequency of ISD. However, the multivariate analysis showed the independent predictor of ISD is only present in grades II and III symptoms in the Stamey classification (P=0.001).
It was found that the more severe the symptoms of urinary incontinence, the higher the possibility of ISD. In other words, the degree of urinary incontinence was found to be one relevant clinical factor in predicting ISD. This finding may help in evaluating and identifying the appropriate surgical technique for EV. Currently, absolute cutoff value to diagnose ISD has not yet been determined. More research is needed to identify clinical factors that can predict ISD.
最近，固有括约肌缺陷（ISD）已被确定为压力性尿失禁（SUI）相关手术预后的一个重要因素。能够预测ISD的临床因素并不常见。本研究的目的是确定女性SUI患者中ISD的预测性临床因素。
根据Valsalva漏尿点压力（VLPP）值将患者分为3组：>90 cm H₂O（解剖性尿失禁，AI）、61至90 cm H₂O（不明确，EV）和<60 cm H₂O（ISD）。所有组均接受全面检查、病史评估、体格检查、尿流率测定和完整的尿动力学研究。分类变量分别采用卡方检验或t检验进行单因素分析。采用Pearson相关分析进行多因素研究，以获得VLPP<60 cm H₂O的临床预测因素。统计学显著性设定为P<0.05。
共有3组，189例患者：56例（AI，29.7%）、64例（EV，33.8%）和69例（ISD，36.5%）。单因素分析显示，ISD与AI之间在最大尿道闭合压（P=0.03）和Stamey分级（P=0.006）方面存在显著差异。尿失禁症状分级越严重，ISD的发生率越高。然而，多因素分析显示，ISD的独立预测因素仅存在于Stamey分级的II级和III级症状中（P=0.001）。
发现尿失禁症状越严重，ISD的可能性越高。换句话说，尿失禁程度是预测ISD的一个相关临床因素。这一发现可能有助于评估和确定适合EV的手术技术。目前，尚未确定诊断ISD的绝对临界值。需要更多研究来确定能够预测ISD的临床因素。
