Is a sequence of tests during urethral pressure profilometry correlated with symptoms assessment in women?

IntroductionOur purpose was, applying a strictly defined protocol for urethral profilometry, 1) to test the repeatability of same session rest maximum urethral closure pressure (MUCP) and 2) to search for correlation between women complaint and the changes in MUCP value (rest and dynamic tests).Materials and MethodsA population of 140 consecutive women referred for evaluation of lower urinary tract dysfunction was stratified in 4 groups according with the urinary symptoms: stress, urge, mixed incontinence and continent and in each group in 3 age groups (young, middle age and old). The sequence of tests recorded in supine position was: urethral pressure profile at rest bladder empty, after bladder filling at 250 mL (reference test), stress profile, fatigability (before (rest) and after 10 successive strong coughs), then in standing position.ResultsIn all groups, there was no significant difference between the two MUCP values at rest bladder filled. In the three incontinent groups, MUCP was higher bladder empty than bladder filled (p < 0.05) except in the young sub-group. Stress incontinence led to significant decrease of MUCP during dynamic tests in the young group. MUCP was not modified after fatigability test in women with urge complaint whatever age.ConclusionWhen recorded following a strictly defined protocol, MUCP at rest bladder filled has a good repeatability in individual. However a complex sequence of tests during urethral pressure profilometry remains discussed in middle-age and old age-groups, it allows specifying the stress component of incontinence in young women and the urgency component in all age-groups.

引言
本研究旨在通过严格定义的尿道压力描记术（urethral profilometry）方案，达成两个研究目标：1）验证同一次检测会话中静息状态下最大尿道闭合压（MUCP）的重复性；2）探寻女性尿路主诉与尿道闭合压（静息及动态检测）变化之间的相关性。

材料与方法
本研究纳入140例因下尿路功能障碍（lower urinary tract dysfunction）就诊的连续女性患者，根据尿路症状分为4组：压力性尿失禁组、急迫性尿失禁组、混合性尿失禁组及无尿失禁组，每组再按年龄分为3个亚组：青年组、中年组及老年组。检测序列设置为：仰卧位下依次完成膀胱排空时的尿道压力描记、膀胱充盈至250mL时的尿道压力描记（参照检测）、压力性描记、疲劳性检测（10次连续剧烈咳嗽前后的静息状态），随后改为站立位完成后续检测。

结果
所有组别中，膀胱充盈状态下的两次静息MUCP值均无显著差异。在3个尿失禁组中，除青年亚组外，膀胱排空时的MUCP均高于膀胱充盈时（p<0.05）。青年压力性尿失禁患者在动态检测中MUCP显著降低。无论年龄如何，存在急迫性尿路主诉的女性在疲劳性检测后MUCP均无明显变化。

结论
按照严格定义的检测方案进行记录时，膀胱充盈状态下的静息MUCP具有良好的个体内重复性。不过，针对中年及老年人群，尿道压力描记术中的复杂检测序列仍存在学术争议，但该方案可明确青年女性尿失禁的压力性成分，以及所有年龄组人群尿失禁的急迫性成分。