Resnick N M, Brandeis G H, Baumann M M, DuBeau C E, Yalla S V
Division of Gerontology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Neurourol Urodyn. 1996;15(6):599-613; discussion 613-8. doi: 10.1002/(SICI)1520-6777(1996)15:6<599::AID-NAU2>3.0.CO;2-A.
Because of the high prevalence of detrusor hyperactivity with impaired contractility (DHIC) in incontinent institutionalized women, we postulated that: 1) single-channel cystometry, the most commonly used diagnostic test, would be inadequate when used alone but that 2) its accuracy could be greatly enhanced by combining it with a previously-performed stress test. To test the hypothesis, we used blinded comparison of a clinical stress test and single-channel cystometry with multichannel videourodynamic evaluation (criterion standard), a strategy designed a priori. Subjects were 97 incontinent women who were considered representative of incontinent nursing home women nationally. With cystometry alone, 9 of 37 women with DHIC (24%) were misdiagnosed as stress-incontinent vs. 1 of 25 with DH (P = .03). In each case, misdiagnosis was due to failure to recognize low-pressure involuntary bladder contractions. Combining cystometry with the stress test improved diagnostic accuracy markedly. Of the 77% of women in whom the results of both tests were congruent, all were correctly classified. When results of the two tests were discordant, neither was superior. Significantly, no woman with stress incontinence was missed by the two-test strategy, nor was anyone with detrusor hyperactivity misclassified. We conclude that in institutionalized elderly women, DHIC commonly mimics other types of urinary tract dysfunction. Thus, single-channel cystometry alone is an inadequate diagnostic test in this population. However, a strategy that combines cystometry with a clinical stress test can correctly classify the majority of such women and identify those in whom the diagnosis is less secure. Use of this simple strategy would facilitate correct diagnosis and initial treatment of most institutionalized women without referral, and also enrich the referred population with those most likely to benefit. Such an approach could significantly improve the approach to this costly and morbid condition.
由于机构收容的失禁女性中逼尿肌活动亢进伴收缩功能受损（DHIC）的患病率较高，我们推测：1）单通道膀胱测压法是最常用的诊断测试，单独使用时并不充分，但2）将其与先前进行的压力测试相结合，其准确性可大大提高。为了验证这一假设，我们采用了临床压力测试和单通道膀胱测压法与多通道视频尿动力学评估（标准对照）的盲法比较，这是一种预先设计的策略。研究对象为97名失禁女性，她们被认为代表了全国范围内失禁养老院女性的情况。仅通过膀胱测压法，37名患有DHIC的女性中有9名（24%）被误诊为压力性失禁，而25名患有逼尿肌过度活动（DH）的女性中有1名被误诊（P = 0.03）。在每种情况下，误诊都是由于未能识别出低压性非自主性膀胱收缩。将膀胱测压法与压力测试相结合可显著提高诊断准确性。在两项测试结果一致的77%的女性中，所有病例均被正确分类。当两项测试结果不一致时，两者均无优势。重要的是，双测试策略没有漏诊任何压力性失禁的女性，也没有将任何逼尿肌活动亢进的女性误诊。我们得出结论，在机构收容的老年女性中，DHIC通常会模仿其他类型的尿路功能障碍。因此，仅单通道膀胱测压法在该人群中是一种不充分的诊断测试。然而，将膀胱测压法与临床压力测试相结合的策略可以正确分类大多数此类女性，并识别出诊断不太明确的女性。使用这种简单的策略将有助于在不转诊的情况下对大多数机构收容女性进行正确诊断和初始治疗，同时也能使转诊人群中最有可能受益的女性增多。这种方法可以显著改善对这种代价高昂且发病的疾病的治疗方法。
