Chassagne S, Bernier P A, Haab F, Roehrborn C G, Reisch J S, Zimmern P E
Department of Urology and Academic Computing Services (Biostatistics), The University of Texas Southwestern Medical Center, Dallas 75235-9110, USA.
Urology. 1998 Mar;51(3):408-11. doi: 10.1016/s0090-4295(97)00634-1.
There is no accepted urodynamic definition of outlet obstruction in women. Currently, the diagnosis is made on the basis of history and radiographic and endoscopic findings. The goal of this study is to design a pressure-flow nomogram (PdetQmax/Qmax) and define cut-off values for obstruction.
Two groups were studied prospectively in an open study: 124 control and 35 clinically obstructed patients. All had a complete history, physical examination, normal neurologic evaluation, cystoscopy, voiding cystography, and urodynamics-with-pressure-flow study. Pressure-flow plot and receiver operator characteristic curves (ROCs) were constructed to determine optimal cut-off values to predict obstruction for peak flow rate (Qmax) and detrusor pressure at maximal flow (PdetQmax).
The etiology of obstruction was previous anti-incontinence surgery (n = 13), large cystocele (n = 11), urethral stricture (n = 6), and other (n = 5). On the basis of ROC curves, using cut-off values of Qmax of 15 mL/s or less and 12 mL/s or less, sensitivity was 85.7% and 71.4%, and specificity 78.2% and 90.3%, respectively. Using cut-off values of PdetQmax of more than 25 and more than 30 cm H2O, sensitivity was 74.3% and 71.4%, and specificity 79.8% and 88.7%, respectively. Using a combined cut-off value of Qmax of 1 5 mL/s or less and PdetQmax of more than 20 cm H2O, sensitivity was 74.3% and specificity was 91.1%.
Based on this prospective, controlled study, preliminary cut-off values were obtained for refining the definition of outlet obstruction in women.
目前尚无被广泛接受的女性下尿路梗阻的尿动力学定义。目前，诊断是基于病史、影像学和内镜检查结果做出的。本研究的目的是设计一个压力-流率列线图（PdetQmax/Qmax）并确定梗阻的临界值。
在一项开放性研究中对两组患者进行前瞻性研究：124名对照者和35名临床诊断为梗阻的患者。所有患者均有完整的病史、体格检查、正常的神经学评估、膀胱镜检查、排尿性膀胱尿道造影以及压力-流率尿动力学研究。构建压力-流率图和受试者操作特征曲线（ROC）以确定预测梗阻的最佳临界值，即最大尿流率（Qmax）和最大尿流时逼尿肌压力（PdetQmax）。
梗阻的病因包括既往抗尿失禁手术（n = 13）、巨大膀胱膨出（n = 11）、尿道狭窄（n = 6）以及其他原因（n = 5）。根据ROC曲线，当Qmax的临界值分别为15 mL/s及以下和12 mL/s及以下时，敏感性分别为85.7%和71.4%，特异性分别为78.2%和90.3%。当PdetQmax的临界值分别为超过25 cm H2O和超过30 cm H2O时，敏感性分别为74.3%和71.4%，特异性分别为79.8%和88.7%。当联合临界值为Qmax 15 mL/s及以下且PdetQmax超过20 cm H2O时，敏感性为74.3%，特异性为91.1%。
基于这项前瞻性对照研究，获得了初步的临界值，以完善女性下尿路梗阻的定义。
