Combined diagnostic modalities improve detection of detrusor external sphincter dyssynergia.
Combined diagnostic modalities improve detection of detrusor external sphincter dyssynergia.
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DOI：
10.5402/2011/323421
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发表时间：
2011-01-01
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影响因子：
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通讯作者：
De, Elise
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作者：
Spettel, Sara;Kalorin, Carmin;De, Elise
导论.逼尿肌-外括约肌协同失调（DESD）的诊断是尿动力学检查中的临床相关发现。然而，关于肌电图（EMG）或排尿性膀胱尿道造影（VCUG）的诊断细节尚未达成共识。我们评价了临床实践中最常用的两种诊断DESD的方法的一致性。方法.患者由一名尿动力学专家在一个学术中心进行前瞻性评估，并由一名独立的尿动力学专家进行回顾性重新评估以获得一致性。通过逼尿肌收缩期间VCUG上的斑片EMG活动增加或膀胱颈/近端尿道扩张来确定DESD。一致性的最低可接受标准设定为70%。结果46名患者被诊断为DESD，两种方式都可用。在这46例患者中，25例通过两种测试进行诊断，11例仅通过VCUG，10例仅通过贴片EMG。二项式检验表明，一致率为54%（95% CI 39%-68%）。结论我们发现这两种模式之间存在显著差异，类似于以前报道的使用针EMG的结果，我们将我们的数据的适用性扩展到大多数使用贴片EMG电极的临床医生。这进一步支持了联合使用EMG和VCUG进行诊断比单独使用任何一种方式可以识别更多DESD病例的想法。
Introduction. The diagnosis of detrusor-external sphincter dyssynergia (DESD) is a clinically relevant finding during urodynamic testing. However, there is no consensus regarding diagnostic specifics of electromyography (EMG) or voiding cystourethrography (VCUG). We evaluated the concordance of the two modalities most commonly used in clinical practice for the diagnosis of DESD. Methods. Patients were prospectively evaluated by a single urodynamicist at an academic center and retrospectively re-evaluated by an independent urodynamicist for agreement. DESD was determined by increased patch EMG activity or a dilated bladder neck/proximal urethra on VCUG during detrusor contraction. Minimal acceptable criterion for agreement was set at 70%. Results. Forty-six patients were diagnosed with DESD with both modalities available. Of these 46 patients, 25 were diagnosed by both tests, 11 by VCUG alone and 10 by patch EMG alone. Binomial testing demonstrated the proportion of agreement was 54% (95% CI 39% to 68%). Conclusion. We found significant disagreement between the two modalities, similar to previously reported findings using needle EMG, and we expand the applicability of our data to the majority of clinicians who use patch EMG electrodes. This further supports the idea that the combined use of EMG and VCUG for diagnosis can identify more cases of DESD than either modality alone.