Swift S E, Ostergard D R
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, USA.
Obstet Gynecol. 1995 Jul;86(1):85-91. doi: 10.1016/0029-7844(95)00106-2.
To determine the sensitivity and specificity of several urodynamic testing methods in the diagnosis of genuine stress urinary incontinence (GSI).
One hundred eight consecutive patients were evaluated prospectively by history and physical examination, cough stress test, and single and multichannel urodynamics. Sensitivities and specificities in detecting genuine stress incontinence were calculated for: a positive cough stress test with a negative cystometrogram, equalization throughout a cough urethral pressure profile, a positive stress leak-point pressure determination, observed urine loss with cough during multichannel urodynamics, and a pressure transmission ratio of less than 90% for each third of the urethra.
Sixty-five patients (60%) were found to have GSI. Observed urine loss with cough during multichannel studies was 91% sensitive and 100% specific. A positive stress leak-point pressure determination had a 78% sensitivity and was 100% specific. A positive cough stress test with a negative cystometrogram was 77% sensitive and 100% specific. Pressure equalization throughout the length of the urethra during a cough urethral pressure profile was 49% sensitive and 98% specific. A pressure transmission ratio of less than 90% in the distal, middle, and proximal urethra had sensitivities and specificities of 54 and 79%, 51 and 65%, and 45 and 58%, respectively. A pressure transmission ratio of less than 90% along the entire length of the urethra was 22% sensitive and 93% specific.
Observed urine loss with cough during multichannel urodynamics was the best examination for diagnosing GSI in our population.
确定几种尿动力学检测方法在诊断真性压力性尿失禁（GSI）中的敏感性和特异性。
对108例连续患者进行前瞻性评估，包括病史和体格检查、咳嗽压力试验以及单通道和多通道尿动力学检查。计算以下各项在检测真性压力性尿失禁时的敏感性和特异性：咳嗽压力试验阳性且膀胱测压图阴性、咳嗽时尿道压力分布图全程压力均衡、压力性漏尿点压力测定阳性、多通道尿动力学检查时咳嗽时观察到尿液漏出，以及尿道各三分之一段压力传递率小于90%。
65例患者（60%）被诊断为GSI。多通道检查时咳嗽时观察到尿液漏出的敏感性为91%，特异性为100%。压力性漏尿点压力测定阳性的敏感性为78%，特异性为100%。咳嗽压力试验阳性且膀胱测压图阴性的敏感性为77%，特异性为100%。咳嗽时尿道压力分布图全程尿道压力均衡的敏感性为49%，特异性为98%。尿道远端、中段和近端压力传递率小于90%时的敏感性和特异性分别为54%和79%、51%和65%、45%和58%。尿道全长压力传递率小于90%时的敏感性为22%，特异性为93%。
多通道尿动力学检查时咳嗽时观察到尿液漏出是我们研究人群中诊断GSI的最佳检查方法。
