Department of Obstetrics and Gynecology, Urogynecology Service, Santa Casa de Sao Paulo School of Medical Sciences, Rua Doutor Cesário Motta Júnior, 61, São Paulo, SP, 01221-020, Brazil.
Department of Surgery, Urology Service, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, SP, Brazil.
World J Urol. 2019 Jan;37(1):189-193. doi: 10.1007/s00345-018-2366-8. Epub 2018 Jun 5.
To investigate Occult Stress Urinary Incontinence (OSUI) using physical exam (PE) and urodynamics (UDS) in women with advanced pelvic organ prolapse (POP), and compare the two methods.
This study comprised 105 women with POP stage-III and -IV, according to POP quantification (POP-Q) system, evaluated prospectively between January and December 2015. A standard history, an incontinence questionnaire and PE were completed before the investigation of the OSUI that was performed in the supine and standing positions, reducing the prolapse using gauze and Cheron dressing forceps. The stress test was performed with and without the prolapse reduction.
The mean patient age was 65.7 years, mean parity 5.1 and mean body mass index 27.4. From a total of 105 patients, 70 (66.7%) presented with POP-Q stage III and 35 (33.3%) stage IV. Sixty-three (60%) women were identified as having OSUI, 27 (25.7%) as continent, and 15 (14.3%) having stress urinary incontinence. From the 63 OSUI subjects, 48 (76.2%) were identified in both evaluations, eight were identified only during PE, and seven only during UDS. The sensitivity to detect OSUI during PE and UDS was 88.9 and 87.3%, respectively (P = .783). The kappa value to measure the agreement between both tests was .648 (95% CI .441-.854).
UDS and PE are equivalent and concordant to demonstrate OSUI, thus it is not necessary to perform UDS to exclusively identify OSUI. UDS utility in OSUI patients, to evaluate urethral and detrusor function, deserves further investigation.
通过体格检查（PE）和尿动力学（UDS）检查评估患有晚期盆腔器官脱垂（POP）的女性是否存在隐匿性压力性尿失禁（OSUI），并比较两种方法。
本研究纳入了 105 名 POP 分期为 III 期和 IV 期的女性患者（根据 POP 量化系统评估），这些患者于 2015 年 1 月至 12 月间接受前瞻性评估。在进行 OSUI 检查前，先完成一份标准病史、尿失禁问卷和体格检查。在仰卧位和站立位检查时，通过使用纱布和 Cheron 牵开器减少脱垂，检查 OSUI。在有或无脱垂减少的情况下进行压力测试。
患者的平均年龄为 65.7 岁，平均产次为 5.1 次，平均体重指数为 27.4。在 105 名患者中，70 名（66.7%）为 POP-Q 分期 III 期，35 名（33.3%）为 IV 期。63 名（60%）女性被诊断为存在 OSUI，27 名（25.7%）为无失禁，15 名（14.3%）为压力性尿失禁。在 63 名 OSUI 患者中，48 名（76.2%）在两种评估中均被发现，8 名仅在体格检查中被发现，7 名仅在 UDS 中被发现。PE 和 UDS 检测 OSUI 的敏感性分别为 88.9%和 87.3%（P=0.783）。两种检查方法之间的一致性kappa 值为 0.648（95%CI 0.441-0.854）。
UDS 和 PE 均可用于检测 OSUI，两种方法等效且一致，因此无需专门进行 UDS 来识别 OSUI。UDS 在 OSUI 患者中用于评估尿道和逼尿肌功能的作用值得进一步研究。
