What type of urinary incontinence does this woman have?
What type of urinary incontinence does this woman have?
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DOI：
10.1001/jama.299.12.1446
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发表时间：
2008-03-26
影响因子：
120.7
通讯作者：
Straus, Sharon E.
中科院分区：
文献类型：
--
作者：
Holroyd-Leduc, Jayna M.;Tannenbaum, Cara;Straus, Sharon E.
尿失禁是一种普遍的状况和治疗方案可以取决于什么类型的尿失禁存在。目的系统回顾门诊评估中确定尿失禁类型的最准确方法的证据。使用Ovid（1966- 2007年7月）和EMBASE（1980- 2007年7月）检索MEDLINE，并检索文章的参考书目，以确定相关研究。搜索词包括尿失禁、诊断测试、病史、体格检查、咳嗽压力测试和尿动力学。研究选择：我们找到了涉及成人尿失禁办公室诊断的英文文章，其中的数据不限于病例报告。纳入了接受病史、体格检查和/或办公室程序（不包括尿动力学）诊断尿失禁类型的患者的队列研究。当从队列研究中获得的数据不足时，考虑病例对照研究。公认的分类失禁类型的参考标准是由专家诊断确认，尿动力学研究，或两者兼而有之。两名研究者独立评估研究质量并提取相关数据。最低纳入标准是所有患者完成适当的参考标准，并能够提取相关数据。40篇文章被确定纳入。采用随机效应模型进行定量综合。男性的数据很少。在女性中，简单问题对诊断压力性尿失禁有一定帮助（总阳性似然比[LR]， 2.2； 95%可信区间[CI]， 1.6- 3.2；总阴性似然比[LR]， 0.39; 95% CI, 0.25- 0.61），但对诊断急迫性尿失禁更有帮助（总阳性似然比，4.2;95% CI, 2.3- 7.6；总阴性似然比，0.48;95% CI, 0.36- 0.62）。膀胱应激试验阳性可能有助于诊断压力性尿失禁（总体LR， 3.1; 95% CI, 1.7- 5.5）；然而，阴性检验没有那么有用（总LR， 0.36; 95% CI, 0.21- 0.60）。结合病史、体格检查和床边检查结果建立临床诊断的系统评估似乎对诊断压力性尿失禁具有中等价值（总阳性LR， 3.7; 95% CI, 2.6- 5.2；总阴性LR， 0.20; 95% CI, 0.08-0.51）。系统评价对诊断急迫性尿失禁的帮助较小（总阳性LR， 2.2; 95% CI, 0.55- 8.7；总阴性LR， 0.63; 95% CI, 0.34- 1.17）。结论诊断急迫性尿失禁最重要的因素是尿急相关的尿失史。膀胱压力测试可能有助于诊断压力性尿失禁。
Context Urinary incontinence is a prevalent condition and treatment options can depend on what type of incontinence is present.Objective To systematically review the evidence about the most accurate way to determine the type of urinary incontinence during an office assessment.Data Sources A search of MEDLINE using Ovid ( 1966- July 2007) and EMBASE ( 1980-July 2007), and the bibliographies of retrieved articles to identify relevant studies. Search terms included urinary incontinence, diagnostic tests, medical history taking, physical examination, cough stress test, and urodynamics.Study Selection English- language articles were identified that addressed the office diagnosis of urinary incontinence in adults, in which data was not limited to case reports. Cohort studies of patients undergoing history, physical examination, and/ or office procedures ( excluding urodynamics) for diagnosing the type of urinary incontinence were included. Case- control studies were considered when there was insufficient data available from cohort studies. The accepted reference standard for categorization of incontinence type was diagnosis confirmed by an expert, urodynamic studies, or both.Data Extraction Two investigators independently appraised study quality and extracted relevant data. Minimum inclusion criteria were completion of an appropriate reference standard in all patients and the ability to extract relevant data.Data Synthesis Forty articles were identified for inclusion. A random- effects model was used for quantitative synthesis. Minimal data was available for men. In women, simple questions modestly helped diagnose stress urinary incontinence ( summary positive likelihood ratio [ LR], 2.2; 95% confidence interval [ CI], 1.6- 3.2; summary negative LR, 0.39; 95% CI, 0.25- 0.61) but are more helpful in diagnosing urge urinary incontinence ( summary positive LR, 4.2; 95% CI, 2.3- 7.6; summary negative LR, 0.48; 95% CI, 0.36- 0.62). A positive bladder stress test may help diagnose stress urinary incontinence ( summary LR, 3.1; 95% CI, 1.7- 5.5); however, a negative test is not as useful ( summary LR, 0.36; 95% CI, 0.21- 0.60). A systematic assessment combining the history, physical examination, and results of bedside tests to establish a clinical diagnosis appears to be of modest value in diagnosing stress urinary incontinence ( summary positive LR, 3.7; 95% CI, 2.6- 5.2; summary negative LR, 0.20; 95% CI, 0.08-0.51). The systematic assessment is less helpful in diagnosing urge urinary incontinence ( summary positive LR, 2.2; 95% CI, 0.55- 8.7; summary negative LR, 0.63; 95% CI, 0.34- 1.17).Conclusions The most helpful component for diagnosing urge urinary incontinence is a history of urine loss associated with urgency. A bladder stress test may be helpful for diagnosing stress urinary incontinence.