Albert Einstein College of Medicine, Bronx, New York, USA.
Can J Urol. 2020 Jun;27(3):10244-10249.
Given the invasive nature of urodynamics and its unclear impact on altering patient management, we aimed to determine whether performing a urodynamic study (UDS) resulted in a change in either patient diagnosis or treatment offered in women with uncomplicated urinary incontinence.
A retrospective review was performed of all female patients who underwent UDS for urinary incontinence at our practice between January 2014 and 2017. Patients with neurogenic lower urinary tract dysfunction, incomplete emptying, urinary retention, or prior anti-incontinence surgery were excluded. We compared the ICD-10 diagnosis and primary treatment offered in the absence of UDS to their post-UDS diagnosis and recommended therapy. Descriptive statistics, chi-squared, and multivariable analyses were performed.
A total of 141 patient charts were analyzed. The indications for UDS were mixed urinary incontinence (MUI) (45.3%), stress urinary incontinence (SUI) (29.1%), and overactive bladder (OAB) (25.5%). A change in diagnosis following UDS was seen in 40.4% of the entire cohort including 53.1% of patients with MUI and 48.8% of those with SUI compared to 8.3% of those with OAB. A change in treatment was seen in 32.6% of patients including 54.9% with MUI, 41.7% with SUI, and 10% with OAB. When compared to patients with SUI on adjusted multivariate logistic regression, those with OAB were less likely to have a change in either diagnosis (OR 0.06 (0.01-0.31)) or management (OR 0.15 (0.04-0.62)).
Diagnosis and management are unlikely to change after UDS in patients presenting with uncomplicated OAB. Conversely, UDS provided important diagnostic information that often changed management in those presenting with MUI and SUI. Our results suggest that UDS may be omitted in patients with uncomplicated refractory OAB in favor of earlier initiation of third line therapies.
鉴于尿动力学检查具有侵袭性，且其对改变患者管理的影响尚不清楚，我们旨在确定在复杂性尿失禁女性患者中进行尿动力学检查（UDS）是否会导致患者诊断或所提供治疗的改变。
对 2014 年 1 月至 2017 年在我们的实践中因尿失禁而接受 UDS 的所有女性患者进行了回顾性研究。排除患有神经源性下尿路功能障碍、排空不全、尿潴留或先前抗失禁手术的患者。我们比较了在没有 UDS 的情况下患者的 ICD-10 诊断和主要治疗方案，以及 UDS 后的诊断和建议治疗。进行了描述性统计、卡方检验和多变量分析。
共分析了 141 份患者病历。UDS 的指征为混合性尿失禁（MUI）（45.3%）、压力性尿失禁（SUI）（29.1%）和膀胱过度活动症（OAB）（25.5%）。在整个队列中，40.4%的患者在 UDS 后出现诊断改变，其中 MUI 患者为 53.1%，SUI 患者为 48.8%，而 OAB 患者为 8.3%。32.6%的患者治疗方案发生改变，其中 MUI 患者为 54.9%，SUI 患者为 41.7%，OAB 患者为 10%。在调整后的多变量逻辑回归中，与 SUI 患者相比，OAB 患者的诊断或管理改变的可能性较小（OR 0.06（0.01-0.31））或管理（OR 0.15（0.04-0.62））。
在出现复杂性 OAB 的患者中，UDS 后诊断和管理不太可能改变。相反，UDS 提供了重要的诊断信息，这通常会改变 MUI 和 SUI 患者的管理。我们的结果表明，对于无并发症的难治性 OAB 患者，UDS 可能会被省略，以便更早地开始三线治疗。
