Van Huele Andries, Bou Kheir George, Wein Alan, Decalf Veerle, Monaghan Thomas F, Hervé François, Everaert Karel
Department of Urology, AZ Alma, 9900 Eeklo, Belgium.
Department of Urology, Ghent University Hospital, 9000 Ghent, Belgium.
Medicina (Kaunas). 2025 Aug 31;61(9):1576. doi: 10.3390/medicina61091576.
: Urinary incontinence (UI) is a prevalent issue among older adults and may require urodynamic studies (UDSs) for accurate diagnosis. However, these procedures can be uncomfortable and time-consuming, especially in a geriatric population, where certain practical restrictions may apply. This study examines whether posture of filling cystometry during UDSs in an older patient group affects diagnostic outcomes and whether a single UDS in one posture is sufficient for a reliable diagnosis or if multiple postures provide added value. : This is a secondary analysis of the Think Dry: Optimalisation of Diagnostic Process of Urinary Incontinence in Older People study (NCT04094753), a prospective observational cohort study. Each patient underwent both sitting and standing filling cystometry during UDS. The final diagnosis was determined by the referring urologist by integrating results from both the sitting and standing groups alongside all available clinical data. Subsequently, each separate UDS was reviewed independently by a second, blinded, urologist, and a diagnosis was established based on a single UDS. The agreement between these independent diagnoses and the final diagnosis was then evaluated using Cohen's kappa coefficient (κ). : Results from the UDS with the standing filling cystometry had an almost perfect agreement (κ = 0.92) with the final diagnosis, compared to only a moderate agreement (κ = 0.42) while sitting. : UDS with standing filling cystometry may be sufficient for an accurate diagnosis, potentially eliminating the need for additional filling cystometry in the sitting position. By streamlining the diagnostic process, this approach could enhance efficiency, reduce patient burden, and optimize resource utilization in older adults.
尿失禁（UI）是老年人中普遍存在的问题，可能需要进行尿动力学研究（UDS）以进行准确诊断。然而，这些检查可能会让人不舒服且耗时，特别是在老年人群中，可能存在某些实际限制。本研究探讨在老年患者组中进行尿动力学检查时，充盈性膀胱测压的姿势是否会影响诊断结果，以及在一种姿势下进行单次尿动力学检查是否足以做出可靠诊断，或者多种姿势是否能提供附加价值。
这是对“Think Dry：老年人尿失禁诊断过程的优化”研究（NCT04094753）的二次分析，该研究是一项前瞻性观察队列研究。每位患者在尿动力学检查期间均进行了坐位和立位充盈性膀胱测压。最终诊断由转诊的泌尿科医生综合坐位和立位组的结果以及所有可用的临床数据来确定。随后，另一位不知情的泌尿科医生独立审查每次单独的尿动力学检查，并基于单次尿动力学检查做出诊断。然后使用科恩kappa系数（κ）评估这些独立诊断与最终诊断之间的一致性。
与坐位时仅为中度一致性（κ = 0.42）相比，立位充盈性膀胱测压的尿动力学检查结果与最终诊断几乎完全一致（κ = 0.92）。
立位充盈性膀胱测压的尿动力学检查可能足以进行准确诊断，有可能无需在坐位进行额外的充盈性膀胱测压。通过简化诊断过程，这种方法可以提高效率、减轻患者负担并优化老年人的资源利用。
