Bump R C
Department of Obstetrics and Gynecology, Virginia Commonwealth University/Medical College of Virginia, Richmond.
Obstet Gynecol. 1993 Mar;81(3):421-5.
To compare black and white women with regard to urinary incontinence and prolapse.
Two hundred consecutive women referred for evaluation of urinary incontinence or severe prolapse, 54 of whom were black, were evaluated. Each had a comprehensive standardized evaluation. Qualitative and quantitative data were analyzed for significant differences between the groups.
The symptoms of pure stress, pure urge, and mixed incontinence were described by 7, 56, and 37% of black subjects, respectively, compared to 31, 28, and 41% of white subjects (P = .001). The conditions of pure genuine stress incontinence (GSI), pure motor incontinence, and mixed incontinence were diagnosed in 27, 56, and 17% of black subjects, respectively, compared to 61, 28, and 11% of whites (P = .0008). Black women with mixed symptoms were significantly less likely than white women to have pure GSI (47 versus 74%; P = .05). Blacks with GSI were significantly heavier, had higher parity, more often took a diuretic, were more often diabetic, and had better passive urethral closure pressure but greater urethral axis mobility than whites. Blacks with motor incontinence were significantly younger, heavier, less likely to have had prior continence surgery or hysterectomy, and had better passive urethral closure pressure but smaller bladder capacities than whites. The prevalence of severe prolapse in this referral population was the same for blacks and whites (24 and 23%), although blacks had significantly more vaginal deliveries. No other significant racial differences were noted in the prolapse group.
Black women with urinary incontinence have a different distribution of symptoms, different conditions causing their incontinence, and different risk profiles for these conditions than do whites. The significantly lower prevalence of pure GSI in black women compared to white women makes the clinical evaluation for GSI appreciably less accurate in the individual black patient. Until further epidemiologic information regarding incontinence in black women is available, such women should be considered candidates for more accurate, sophisticated urodynamic testing before continence surgery.
比较黑人女性与白人女性在尿失禁和盆腔器官脱垂方面的情况。
对连续转诊来评估尿失禁或严重盆腔器官脱垂的200名女性进行了评估，其中54名是黑人女性。每位患者都接受了全面的标准化评估。对定性和定量数据进行分析，以比较两组之间的显著差异。
黑人受试者中分别有7%、56%和37%出现单纯压力性尿失禁、单纯急迫性尿失禁和混合性尿失禁症状，相比之下，白人受试者中这一比例分别为31%、28%和41%（P = 0.001）。黑人受试者中分别有27%、56%和17%被诊断为单纯真性压力性尿失禁（GSI）、单纯运动性尿失禁和混合性尿失禁，相比之下，白人中这一比例分别为61%、28%和11%（P = 0.0008）。有混合症状的黑人女性比白人女性患单纯GSI的可能性显著更低（47%对74%；P = 0.05）。患有GSI的黑人比白人体重更重、产次更高、更常服用利尿剂、患糖尿病的几率更高，被动尿道闭合压更好，但尿道轴活动度更大。患有运动性尿失禁的黑人比白人更年轻、体重更重、更不太可能接受过尿失禁手术或子宫切除术，被动尿道闭合压更好，但膀胱容量更小。在这个转诊人群中，黑人与白人严重盆腔器官脱垂的患病率相同（分别为24%和23%），尽管黑人的阴道分娩次数显著更多。在盆腔器官脱垂组中未发现其他显著的种族差异。
患有尿失禁的黑人女性与白人女性在症状分布、导致尿失禁的病因以及这些病因的风险特征方面存在差异。与白人女性相比，黑人女性中单纯GSI的患病率显著更低，这使得对个体黑人患者进行GSI的临床评估准确性明显降低。在获得更多关于黑人女性尿失禁的流行病学信息之前，在进行尿失禁手术前，这类女性应被视为更准确、更复杂的尿动力学检测的候选对象。
