Department and Clinical Institute of Gynaecology, Obstetrics and Neonatology, Hospital Clinic I Provincial, University of Barcelona, Barcelona, Spain.
Department of Obstetrics and Gynaecology, Donostia University Hospital, San Sebastián, Spain.
Neurourol Urodyn. 2020 Feb;39(2):819-825. doi: 10.1002/nau.24288.
To evaluate the diagnostic ability of different cough stress tests (CSTs) in women with pelvic organ prolapse (POP), performed during outpatient urogynaecological exams.
Prospective, multicentre observational study involving women on waiting lists for POP surgery. With a subjectively full bladder, patients were asked to perform five different CSTs: without prolapse reduction ([a] standing, followed by [b] semilithotomy position); keeping semilithotomy position with prolapse reduced (by [c] posterior speculum, followed by [d] pessary); [e] standing again with the pessary in place. Primary outcome was positive CST in at least one of the five CSTs. Bladder volume was measured and symptoms of stress urinary incontinence (SUI) were detected by two validated questionnaires.
A total of 297 women completed all CSTs and were included in the analyses. Mean (SD) age, parity, and body mass index were 64.8 (9.9) years, 2.7 (1.3) deliveries, and 26.6 (3.4) kg/m , respectively. In total, 99 women (33.3%) reported SUI symptoms. At least one positive CST was recorded in 152 patients (51.1%), and in 90 (59.2%) of these 152, a positive CST was observed only when POP was reduced (occult SUI). The CST was positive in 92 (92.9%) of the 99 patients with coexisting SUI symptoms and in 60 (30.3%) of the 205 asymptomatic patients. The percentage of patients with a positive CST was significantly lower when bladder volume was <200 mL vs ≥200 mL (P = .046).
The identification of urinary leakage cases with CSTs is best achieved using multiple different patient positions, different prolapse reduction methods, and bladder volumes ≥200 mL.
评估不同咳嗽压力测试（CST）在患有盆腔器官脱垂（POP）的女性中的诊断能力，这些测试在门诊妇科泌尿科检查期间进行。
前瞻性、多中心观察性研究，涉及等待 POP 手术的女性患者。在主观上膀胱充盈的情况下，要求患者进行五次不同的 CST：不脱垂减轻（[a]站立，随后[b]半坐卧位）；脱垂减轻时保持半坐卧位（通过[c]后窥器，随后[d]子宫托）；[e]再次站立，同时放置子宫托。主要结果是在至少五次 CST 中的一次 CST 为阳性。测量膀胱容量，并通过两个经过验证的问卷检测压力性尿失禁（SUI）的症状。
共有 297 名女性完成了所有 CST 并纳入分析。平均（SD）年龄、产次和体重指数分别为 64.8（9.9）岁、2.7（1.3）次分娩和 26.6（3.4）kg/m 。共有 99 名女性（33.3%）报告有 SUI 症状。至少有一次 CST 阳性的患者有 152 例（51.1%），在这 152 例中，90 例（59.2%）仅在脱垂减轻时 CST 为阳性（隐匿性 SUI）。同时患有 SUI 症状的 99 名患者中有 92 名（92.9%） CST 阳性，205 名无症状患者中有 60 名（30.3%） CST 阳性。膀胱容量<200ml 时 CST 阳性的患者比例明显低于膀胱容量≥200ml 时（P=0.046）。
使用多种不同的患者体位、不同的脱垂减轻方法和膀胱容量≥200ml 可以更好地通过 CST 识别尿漏病例。
