Urodynamic Investigation: A Valid Tool to Define Normal Lower Urinary Tract Function?
Urodynamic Investigation: A Valid Tool to Define Normal Lower Urinary Tract Function?
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DOI：
10.1371/journal.pone.0163847
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发表时间：
2016-10-13
期刊：
影响因子：
3.7
通讯作者：
Kessler, Thomas M.
中科院分区：
文献类型：
--
作者：
Leitner, Lorenz;Walter, Matthias;Kessler, Thomas M.
目的评价尿动力学检查（UDI）作为评价难治性下尿路症状（LUTS）的金标准是否适合选择下尿路功能明显正常的健康志愿者作为对照组进行比较研究。（22名女性，平均年龄32 +/- 10岁; 20名男性，平均年龄37 +/- 12岁）未发生LUTS的患者被纳入该前瞻性单中心队列研究。所有受试者记录3天膀胱日记，完成关于LUTS的有效问卷，并进行神经泌尿学评估以及自由尿流率测定。同一届会议重复UDI进行根据“良好的尿动力学实践”推荐的国际尿失禁协会，但使用充气而不是充满水的导管，并由一个盲investigator.ResultsAll 3天的膀胱日记，LUTS问卷，神经泌尿系统评估和自由尿流率在正常范围内。整体（在第一次或第二次UDI期间），同一次重复UDI显示71%（30/42）的病理结果：逼尿肌过度活动分别为14%（3/22）和30%（6/20），排尿后残余尿量> 100 mL分别为14%（3/22）和25%（5/20），膀胱出口梗阻分别为9%（2/22）和20%（4/20），逼尿肌括约肌协同失调分别为77%（17/22）和65%（13/20）。（k = 0.78，95%CI：0.54-1.02）和逼尿肌括约肌协同失调（k = 0.77，95%CI：0.55-0.98）显示两种UDI之间基本一致。所有其他评估的尿动力学参数有广泛的95%的范围内的参数表示较差的repetitive.ConclusionsMore的差异的协议，我们的健康受试者的70%以上的病理尿动力学结果。尽管UDI是评估难治性LUTS的金标准，但其似乎不适用于健康受试者以定义正常的下尿路功能。因此，我们不建议使用UDI选择健康对照受试者。
ObjectivesTo evaluate whether urodynamic investigation (UDI), the gold standard to assess refractory lower urinary tract symptoms (LUTS), is appropriate to select healthy volunteers with apparent normal lower urinary tract function as control subjects for comparative studies.Subjects and Methods42 healthy subjects (22 women, mean age 32 +/- 10 years; 20 men, mean age 37 +/- 12 years) without LUTS were included into this prospective single-centre cohort study. All subjects recorded a 3-day bladder diary, completed validated questionnaires regarding LUTS, and underwent neuro-urological assessment as well as free uroflowmetry. Same session repeat UDI was performed according to "Good Urodynamic Practice "recommended by the International Continence Society, but using an air-charged instead of a water-filled catheter, and evaluated by a blinded investigator.ResultsAll 3-day bladder diaries, LUTS questionnaires, neuro-urological assessments and free uroflowmetries were within normal limits. Overall (either during the first or second UDI), same session repeat UDI revealed pathological findings in 71% (30/42): Detrusor overactivity was detected in 14% (3/22) and 30% (6/20), post void residual >100mL in 14% (3/22) and 25% (5/20), bladder outlet obstruction in 9% (2/22) and 20% (4/20) and detrusor sphincter dyssynergia in 77% (17/22) and 65% (13/20) of our women and men, respectively.Repeatability of detrusor overactivity (k = 0.78, 95% CI: 0.54-1.02) and detrusor sphincter dyssynergia (k = 0.77,95% CI: 0.55-0.98) showed substantial agreement between both UDIs. All other assessed urodynamic parameters had wide 95% limits of agreement for differences in the parameters indicating poor repeatability.ConclusionsMore than 70% of our healthy subjects showed pathological urodynamic findings. Although UDI is the gold standard to assess refractory LUTS, it seems not to be applicable in healthy subjects to define normal lower urinary tract function. Therefore, we do not recommend using UDI to select healthy control subjects.