McGuire E J
Division of Urology, University of Texas Medical School at Houston, USA.
Urol Clin North Am. 1995 Aug;22(3):551-5.
A careful history points the urodynamic examination in the right direction and enables the examiner to ask the correct questions. The individual who does the test is the only reliable interpreter of the results of that study. No urodynamic technique is as sensitive or specific as a blood glucose, or even an electrocardiogram. A history of urgency and urge incontinence suggests uninhibited contractility and is a better index of that condition than a cystometrogram. Leakage occurring shortly after a previous operative procedure for stress incontinence suggests type III stress incontinence. A past history of radiation, prior pelvic surgery, neurologic disease, herniated disc conditions, or prior chemotherapy all require a simple cystometrogram to rule out abnormal bladder compliance. Following a simple history and urodynamic evaluation, a physical examination should be performed, searching for urethra hypermobility and genital prolapse. Abdominal leak-point pressure testing is useful to assign broad categories of incontinence. Relatively high leak-point pressures with hypermobility suggest suspension operations will be effective. Low leak-point pressures with hypermobility often require a sling, and very low leak-point pressures with no hypermobility indicate a suitable candidate for a trial of injection therapy.
详细的病史能为尿动力学检查指明正确方向，使检查者能够提出恰当的问题。进行该项检查的人员是该研究结果的唯一可靠解读者。没有任何尿动力学技术能像血糖检测甚至心电图那样敏感或特异。尿急和急迫性尿失禁病史提示存在无抑制性收缩，相较于膀胱测压，它是该病症更好的指标。既往压力性尿失禁手术治疗后不久出现漏尿提示Ⅲ型压力性尿失禁。既往有放疗史、盆腔手术史、神经系统疾病、椎间盘突出症或化疗史，均需要进行简单的膀胱测压以排除膀胱顺应性异常。在进行简单的病史询问和尿动力学评估后，应进行体格检查，以查找尿道活动过度和生殖器脱垂情况。腹部漏尿点压力测试有助于对尿失禁进行大致分类。尿道活动过度时相对较高的漏尿点压力提示悬吊手术可能有效。尿道活动过度时较低的漏尿点压力通常需要使用吊带，而无尿道活动过度时极低的漏尿点压力表明是注射治疗试验的合适人选。
