Jensen J K, Nielsen F R, Ostergard D R
Long Beach Memorial Medical Center, University of California, Irvine.
Obstet Gynecol. 1994 May;83(5 Pt 2):904-10.
To assess the clinical usefulness and validity of patient history in the diagnosis of genuine stress incontinence and detrusor overactivity.
A literature search was performed for publications addressing the clinical evaluation of urinary incontinence between 1975-1992.
Nineteen of 29 articles during this period reported data in such a manner as to allow statistical comparison of patient history to the diagnosis based on urodynamic evaluation.
Each article was assessed for the following information: inclusion and exclusion criteria, method of obtaining patient history, clinical evaluation, and diagnostic criteria. Patients in each article were classified according to their history and urodynamic diagnosis. Sensitivity, specificity, and predictive values were calculated for each article, as well as for the combined data from all articles. Combined data from all 19 articles produced a total of 3092 and 2950 patients evaluated for genuine stress incontinence and detrusor overactivity, respectively. A clinical history consistent with stress incontinence, when compared to a urodynamically based diagnosis, showed a sensitivity of 0.906, a specificity of 0.511, a positive predictive value of 0.749, and a negative predictive value of 0.771. A comparison of clinical history suggestive of an overactive detrusor and urodynamic evidence of spontaneous bladder activity revealed a sensitivity of 0.735, specificity of 0.552, positive predictive value of 0.561, and negative predictive value of 0.728.
Patient history alone is not an accurate tool in the diagnosis of genuine stress incontinence or detrusor overactivity, and should not be the sole determinant of diagnosis or treatment.
评估患者病史在诊断真性压力性尿失禁和逼尿肌过度活动中的临床实用性和有效性。
对1975年至1992年间关于尿失禁临床评估的出版物进行了文献检索。
在此期间的29篇文章中有19篇以允许对患者病史与基于尿动力学评估的诊断进行统计比较的方式报告了数据。
对每篇文章评估以下信息：纳入和排除标准、获取患者病史的方法、临床评估和诊断标准。根据每篇文章中患者的病史和尿动力学诊断进行分类。计算每篇文章以及所有文章综合数据的敏感性、特异性和预测值。所有19篇文章的综合数据分别产生了总共3092例和2950例接受真性压力性尿失禁和逼尿肌过度活动评估的患者。与基于尿动力学的诊断相比，与压力性尿失禁一致的临床病史显示敏感性为0.906，特异性为0.511，阳性预测值为0.749，阴性预测值为0.771。对提示逼尿肌过度活动的临床病史与自发性膀胱活动的尿动力学证据进行比较，显示敏感性为0.735，特异性为0.552，阳性预测值为0.561，阴性预测值为0.728。
仅依靠患者病史并非诊断真性压力性尿失禁或逼尿肌过度活动的准确工具，不应作为诊断或治疗的唯一决定因素。
