Stop test or pressure-flow study? Measuring detrusor contractility in older females
Stop test or pressure-flow study? Measuring detrusor contractility in older females
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DOI：
10.1002/nau.20020
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发表时间：
2004-01-01
影响因子：
2
通讯作者：
Resnick, NM
中科院分区：
文献类型：
--
作者：
Tan, TL;Bergmann, MA;Resnick, NM
目的：逼尿肌收缩力受损在老年人中很常见。一方面，排尿期间的逼尿肌收缩强度通过在流量为时所达到的等容逼尿肌压力来测量（停止测试）。然而，由于中断在实践中很困难，因此基于不间断排尿期间进行的测量的简单中断机械指数或列线图是一种有吸引力的替代方案。我们研究了这种最初为男性开发的方法是否适用于女性受试者，并试图找出一种最佳方法。方法：我们将停止测试等容压与基于一组患有急迫性尿失禁的老年妇女的压力流量研究的估计值进行比较。在安慰剂或奥昔布宁治疗前和治疗后进行测量，以便研究重测的可靠性和对收缩性微小变化的反应性。结果：现有的通过压力-流量研究估计逼尿肌收缩强度的方法，包括谢弗收缩列线图和预计等容压 PIP，大大高估了这些女性患者的等容压。简单的修改可提供更可靠的估计值 PIP1，等于 P-det.Qmax + Q(max)（压力单位为 cmH(2)O，Q(max) 单位为 ml/sec）。通常，在急迫性尿失禁的老年女性群体中，PIP1 的范围为 30 至 75 cmH(2)O。然而，PIPI 对 a 的响应较差。收缩强度的变化比机械中断测量的等容压小。结论：参数 PIP 在标准压力流量研究中计算起来很简单，可能有助于老年女性逼尿肌收缩强度的临床评估。然而，对于研究而言，机械停止测试仍然是最可靠、反应最灵敏的方法。 Schafer 收缩力列线图和相关参数（例如 DECO 和 BCI）不适合老年女性使用。 (C) 2004 Wiley-Liss, Inc.
Aims: Impaired detrusor contractility is common in older adults. One aspect, detrusor contraction strength during voiding, call be measured by the isovolumetric detrusor pressure attained if flow is, (a stop test). Because interruption is awkward in practice, however, simple interrupted mechanically indices or nomograms based on measurements made during uninterrupted voiding are an appealing alternative. We investigated whether such methods, originally developed for males, might be applicable in female subjects, and attempted to identify a single best method. Methods: We compared stop-test isovolumetric pressures with estimates based on pressure-flow studies in a group of elderly Women suffering from urge incontinence. Measurements were made pre- and post-treatment with placebo or oxybutynin, allowing investigation of test-retest reliability and responsiveness to small changes of contractility. Results: Existing methods of estimating detrusor contraction strength from pressure-flow studies, including the Schafer contractility nomogram and the projected isovolumetric pressure PIP, greatly overestimate the isovolumetric pressure in these female patients. A simple modification provides a more reliable estimate, PIP1, equal to P-det.Qmax + Q(max) (with pressure in cmH(2)O and Q(max) in ml/sec). Typically PIP1 ranges from 30 to 75 cmH(2)O in this population of elderly urge-incontinent women. PIPI, however, is less responsive to a. small change in contraction strength than the isovolumetric pressure measured by mechanical interruption. Conclusions: The parameter PIP, is simple to calculate front a standard pressure-flow study and may be useful for clinical assessment of detrusor contraction strength in older females. For research, however, a mechanical stop test still remains the most reliable and responsive method. The Schafer contractility nomogram and related parameters such as DECO and BCI are not suitable for use in older women. (C) 2004 Wiley-Liss, Inc.