Can we predict urinary stress incontinence by using demographic, clinical, imaging and urodynamic data?
Can we predict urinary stress incontinence by using demographic, clinical, imaging and urodynamic data?
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DOI：
10.1016/j.ejogrb.2015.07.012
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发表时间：
2015-10-01
影响因子：
2.6
通讯作者：
Dietz, Hans P.
中科院分区：
文献类型：
--
作者：
Wlazlak, Edyta;Surkont, Grzegorz;Dietz, Hans P.
目的：尿道活动过度和静息尿道压力在很大程度上解释了女性压力性尿失禁。在这项研究中，我们试图在未选择的女性尿动力学测试队列中重复这些发现，包括尽可能多的潜在混杂因素。研究设计：本研究对341名女性的数据进行回顾性分析。由于盆底功能障碍的症状，他们接受了尿动力学检查。我们从分析中排除了既往有过尿失禁和脱垂手术史的女性。所有患者均进行标准化临床评估、4D经会阴盆底超声和多通道尿动力学检查。尿动力应激性尿失禁（USI）采用多通道尿动力试验诊断。其严重程度主观上分为轻度、中度和重度。候选变量为：年龄、BMI、脱垂症状、阴道胎次、明显脱垂（室特异性）、提上睑肌撕脱、提上睑肌裂孔面积、牛津分级、尿道中流动性、最大尿道压力（MUP）、最大咳嗽压力和最大Valsalva压力。结果：经二元logistic回归分析，年龄（P = 0.03）、显著性直肠膨出（P = 0.02）、最大尿量（max）、尿动力性应激性尿失禁的预测有统计学意义。腹压达到（阴性，P < 0.0001），尿道中流动性达到（P = 0.0004）， MUP达到（阴性，P < 0.0001）。在多变量分析中，考虑到多重相互依赖性，以下预测因子仍然显著：腹压（阴性，P < 0.0001）、咳压（P = 0.006）、中尿道活动性（P = 0.003）和MUP（阴性，P < 0.0001）， R-2为0.24。结论：中尿道运动和MUP是USI的主要预测因素。人口统计和临床数据充其量只是微弱的预测因素。我们的结果表明存在未被识别的主要混杂因素。(C) 2015年由爱思唯尔爱尔兰有限公司出版。
Objective: It has been claimed that urethral hypermobility and resting urethral pressure can largely explain stress incontinence in women. In this study we tried to replicate these findings in an unselected cohort of women seen for urodynamic testing, including as many potential confounders as possible.Study design: This study is a retrospective analysis of data obtained from 341 women. They attended for urodynamic testing due to symptoms of pelvic floor dysfunction. We excluded from the analysis women with a history of previous anti-incontinence and prolapse surgery. All patients had a standardised clinical assessment, 4D transperineal pelvic floor ultrasound and multichannel urodynamic testing. Urodynamic stress incontinence (USI) was diagnosed by multichannel urodynamic testing. Its severity was subjectively graded as mild, moderate and severe. Candidate variables were: age, BMI, symptoms of prolapse, vaginal parity, significant prolapse (compartment-specific), levator avulsion, levator hiatal area, Oxford grading, midurethral mobility, maximum urethral pressure (MUP), maximum cough pressure and maximum Valsalva pressure reached.Results: On binary logistic regression, the following parameters were statistically significant in predicting urodynamic stress incontinence: age (P = 0.03), significant rectocele (P = 0.02), max. abdominal pressure reached (negatively, P < 0.0001), midurethral mobility (P = 0.0004) and MUP (negatively, P < 0.0001). On multivariate analysis, accounting for multiple interdependencies, the following predictors remained significant: max. abdominal pressure reached (negatively, P < 0.0001), cough pressure (P = 0.006), midurethral mobility (P = 0.003) and MUP (negatively, P < 0.0001), giving an R-2 of 0.24.Conclusions: Mid-urethral mobility and MUP are the main predictors of USI. Demographic and clinical data are at best weak predictors. Our results suggest the presence of major unrecognised confounders. (C) 2015 Published by Elsevier Ireland Ltd.