Ng R K, Murray A
Department of Gynaecology, Arrowe Park Hospital, Wirral, Merseyside, UK.
Singapore Med J. 1993 Apr;34(2):121-4.
Is urodynamics necessary in the management of female stress urinary incontinence? This has remained a point of contention among urologists and gynaecologists alike. In this prospective study we evaluated 28 patients urodynamically to assess our diagnostic accuracy and to audit our intended management. These patients had complained solely or predominantly of stress incontinence. None of them had previous abdominal or vaginal surgery for stress urinary incontinence or a history suggestive of voiding disorder. All 28 of them were listed for either a Burch colposuspension or Stamey endoscopic bladder neck suspension operation based on demonstrating the sign stress incontinence clinically or radiologically on screening cystography. In all these cases the diagnosis of genuine stress incontinence was presumed and urodynamics would not have been performed preoperatively, if not for this study. As a result, there was a 21% overall change in the intended management. Routine but simplified urodynamics (to include pad test, provocative cystometry, uroflowmetry and residual urine measurement) would appear to be a pre-requisite of genuine stress incontinence surgery, even in patients complaining solely of stress incontinence.
尿动力学检查在女性压力性尿失禁的治疗中是否必要？这一直是泌尿外科医生和妇科医生之间争论的焦点。在这项前瞻性研究中，我们对28例患者进行了尿动力学评估，以评估我们的诊断准确性并审核我们预期的治疗方案。这些患者仅主诉或主要主诉为压力性尿失禁。他们中没有人曾因压力性尿失禁接受过腹部或阴道手术，也没有提示排尿障碍的病史。根据临床或筛查膀胱造影放射学检查显示压力性尿失禁体征，这28例患者均被列入接受Burch阴道旁修补术或Stamey内镜膀胱颈悬吊术。在所有这些病例中，均假定为真性压力性尿失禁诊断，若不是因为这项研究，术前不会进行尿动力学检查。结果，预期的治疗方案总体上有21%的改变。常规但简化的尿动力学检查（包括尿垫试验、激发性膀胱测压、尿流率测定和残余尿量测量）似乎是真性压力性尿失禁手术的先决条件，即使是仅主诉压力性尿失禁的患者。
