Wall L L, Wiskind A K, Taylor P A
Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
Am J Obstet Gynecol. 1994 Dec;171(6):1472-7; discussion 1477-9. doi: 10.1016/0002-9378(94)90390-5.
Our purpose was to compare the diagnostic efficacy of observing urine loss during simple bladder filling (without pressure measurement) and a cough stress test, with multichannel subtracted cystometry.
The urodynamic records of 77 women complaining of urinary incontinence were reviewed. All women had undergone a full evaluation that included a standardized history and physical examination, urinalysis and urine culture, uroflowmetry with measurement of postvoid residual urine, a cough stress test performed during and after simple retrograde bladder filling, and multichannel subtracted cystometry. The results of simple bladder filling and the cough stress test were recorded as "urge incontinence," "stress incontinence,"mixed incontinence," or "incontinence not demonstrated." The subtracted cystometrogram was then performed, and the urodynamic diagnoses were recorded as "detrusor instability," "genuine stress incontinence," "mixed incontinence," or "incontinence not demonstrated." The records were reviewed, and the results of simple bladder filling with a cough stress test were compared with those obtained by subtracted multichannel provocative cystometry.
With the subtracted multichannel cystometrogram used as the "gold standard" for diagnosis, the demonstration of "urge incontinence" during simple bladder filling had a sensitivity of 64% and a specificity of 86.8% for the demonstration of detrusor instability during cystometry, with a positive predictive value of 83.3% and a negative predictive value of 70.2%. The demonstration of "stress incontinence" during simple bladder filling had a sensitivity of 88.1% and a specificity of 77.1% for the demonstration of "genuine" stress incontinence during cystometry, with a positive predictive value of 82% and a negative predictive value of 84.4%.
The demonstration of urge incontinence during simple bladder filling is a reliable predictor of detrusor instability, but its absence is less reliable in excluding detrusor overactivity as a cause of urinary incontinence. Similarly, the clinical demonstration of stress incontinence during simple bladder filling is predictive of the presence of "genuine" stress incontinence during subtracted multichannel provocative cystometry. The inability to demonstrate stress incontinence during simple bladder filling is highly correlated with the absence of "genuine" stress incontinence during complex urodynamic testing. Simple bladder filling is a reliable method of diagnosing urinary incontinence. In many cases it can replace complex urodynamic testing, particularly if the proposed treatment for the condition carries a low level of risk, and is helpful in selecting patients who need more extensive evaluation.
我们的目的是比较单纯膀胱充盈（不进行压力测量）及咳嗽压力试验时观察尿失禁情况与多通道减法膀胱测压法的诊断效能。
回顾了77例主诉尿失禁女性的尿动力学记录。所有女性均接受了全面评估，包括标准化病史及体格检查、尿液分析及尿培养、测量排尿后残余尿量的尿流率测定、单纯逆行膀胱充盈期间及之后进行的咳嗽压力试验，以及多通道减法膀胱测压。单纯膀胱充盈及咳嗽压力试验的结果记录为“急迫性尿失禁”“压力性尿失禁”“混合性尿失禁”或“未显示尿失禁”。然后进行减法膀胱测压图检查，并将尿动力学诊断记录为“逼尿肌不稳定”“真性压力性尿失禁”“混合性尿失禁”或“未显示尿失禁”。对记录进行回顾，并将单纯膀胱充盈联合咳嗽压力试验的结果与多通道激发性减法膀胱测压的结果进行比较。
将多通道减法膀胱测压图用作诊断的“金标准”时，单纯膀胱充盈期间显示“急迫性尿失禁”对于膀胱测压期间逼尿肌不稳定的显示，敏感性为64%，特异性为86.8%，阳性预测值为83.3%，阴性预测值为70.2%。单纯膀胱充盈期间显示“压力性尿失禁”对于膀胱测压期间“真性”压力性尿失禁的显示，敏感性为88.1%，特异性为77.1%，阳性预测值为82%，阴性预测值为84.4%。
单纯膀胱充盈期间显示急迫性尿失禁是逼尿肌不稳定的可靠预测指标，但未显示急迫性尿失禁在排除逼尿肌过度活动作为尿失禁原因方面可靠性较低。同样，单纯膀胱充盈期间压力性尿失禁的临床显示可预测多通道激发性减法膀胱测压期间“真性”压力性尿失禁的存在。单纯膀胱充盈期间无法显示压力性尿失禁与复杂尿动力学检查期间不存在“真性”压力性尿失禁高度相关。单纯膀胱充盈是诊断尿失禁的可靠方法。在许多情况下，它可替代复杂的尿动力学检查，特别是如果针对该病症拟采取的治疗风险较低时，并且有助于选择需要更广泛评估的患者。
