Roberts Kasey, Alfahmy Anood, Mitchell Diana, Kamumbu Stacy, Sebikali-Potts Audry, Sheyn David
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Division of Female Pelvic Medicine and Reconstructive Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Int Urogynecol J. 2023 Apr;34(4):897-904. doi: 10.1007/s00192-022-05276-5. Epub 2022 Jun 28.
Pre-procedure urinalysis may add unnecessary cost and inconvenience for patients undergoing urodynamics. The hypothesis of this study was that urinalysis would perform poorly when predicting complications following urodynamics.
Case-control study of women aged 18-89 undergoing urodynamics from 01 January2008 to 31 December 2017 at two tertiary medical centers. Data collected included patient demographics, past medical history, lower urinary tract symptoms, urodynamics indication, urodynamics results, urinalysis result, antibiotic administration, and adverse events within 30 days. Wilcoxon rank-sum test was used to compare those with and without an adverse event. Logistic regression was performed using statistically significant variables on pairwise analysis.
A total of 601 patients met the criteria; 11 of these experienced an adverse event, of which all were a urinary tract infection. There were no differences in the frequency of adverse events based on any urinalysis result, regardless of whether the patient received antibiotics. On pairwise analysis, variables associated with a higher frequency of adverse events were higher parity (3.5 (2-5) vs 2 (2, 3), p=0.038) and complaint of suprapubic pain (1 (9.1%) vs 4 (0.7%), p=0.002). On logistic regression, significant variables included increasing age (adjusted odds ratio [aOR] 1.03 per year (95% CI 1.03-4.06); p=0.002), any prolapse (aOR 6.45 (95% CI 3.60-11.54); p<0.001), pelvic organ prolapse as the indication for urodynamics (aOR 7.27 (95% CI 2.60-20.36); p<0.001), and a diagnosis of stress urinary incontinence (4.98 (95% CI 1.95-12.67); p<0.001).
The frequency of adverse events after urodynamics is low, and urinalysis in asymptomatic patients does not seem to be useful in predicting morbidity.
对于接受尿动力学检查的患者，检查前的尿液分析可能会增加不必要的费用并给患者带来不便。本研究的假设是，尿液分析在预测尿动力学检查后的并发症方面表现不佳。
对2008年1月1日至2017年12月31日在两家三级医疗中心接受尿动力学检查的18 - 89岁女性进行病例对照研究。收集的数据包括患者人口统计学信息、既往病史、下尿路症状、尿动力学检查指征、尿动力学检查结果、尿液分析结果、抗生素使用情况以及30天内的不良事件。采用Wilcoxon秩和检验比较发生和未发生不良事件的患者。使用成对分析中具有统计学意义的变量进行逻辑回归分析。
共有601名患者符合标准；其中11名经历了不良事件，所有不良事件均为尿路感染。无论尿液分析结果如何，无论患者是否接受抗生素治疗，不良事件的发生率均无差异。在成对分析中，与不良事件发生率较高相关的变量是较高的产次（3.5（2 - 5）对2（2, 3），p = 0.038）和耻骨上疼痛主诉（1（9.1%）对4（0.7%），p = 0.002）。在逻辑回归分析中，显著变量包括年龄增长（调整后的优势比[aOR]为每年1.03（95%可信区间1.03 - 4.06）；p = 0.002）、任何脱垂（aOR 6.45（95%可信区间3.60 - 11.54）；p < 0.001）、盆腔器官脱垂作为尿动力学检查的指征（aOR 7.27（95%可信区间2.60 - 20.36）；p < 0.001）以及压力性尿失禁的诊断（4.98（95%可信区间1.95 - 12.67）；p < 0.001）。
尿动力学检查后不良事件的发生率较低，无症状患者的尿液分析似乎对预测发病率没有帮助。
