Standing cough test stratification of moderate male stress urinary incontinence

ABSTRACT Purpose: Patient-reported history of pads per day (PPD) is widely recognized as a fundamental element of decision-making for anti-incontinence procedures. We hypothesize that SUI severity is often underestimated among men with moderate SUI. We sought to compare patient history of incontinence severity versus objective in-office physical examination findings. Materials and Methods: We retrospectively reviewed our single-surgeon male SUI surgical database from 2007-2019. We excluded patients with incomplete preoperative or postoperative data and those who reported either mild or severe SUI, thus having more straightforward surgical counseling. For men reported to have moderate SUI, we determined the frequency of upgrading SUI severity by recording the results of an in-office standing cough test (SCT) using the Male Stress Incontinence Grading Scale (MSIGS). The correlation of MSIGS with sling success rate was calculated. Failure was defined as >1 PPD usage or need for additional incontinence procedure. Results: Among 233 patients with reported moderate SUI (2-3 PPD), 89 (38%) had MSIGS 3-4 on SCT, indicating severe SUI. Among patients with 2-3 PPD preoperatively, sling success rates were significantly higher for patients with MSIGS 0-2 (76/116, 64%) compared to MSIGS 3-4 (6/18, 33%) (p <0.01). Conclusions: Many men with self-reported history of moderate SUI actually present severe SUI observed on SCT. The SCT is a useful tool to stratify moderate SUI patients to more accurately predict sling success.

摘要
研究目的：患者每日尿垫使用量（pads per day，PPD）的自我报告史，被广泛视为抗尿失禁手术决策的核心依据。我们假设，中度压力性尿失禁（Stress Urinary Incontinence，SUI）男性患者的病情严重程度常被低估。本研究旨在对比患者自我报告的尿失禁严重程度与门诊客观体格检查结果。
材料与方法：我们回顾性分析了2007年至2019年间由单主刀医师接诊的男性压力性尿失禁手术数据库。排除术前或术后数据不全者，以及自我报告为轻度或重度压力性尿失禁的患者——此类患者的手术咨询流程相对明确。对于自我报告为中度压力性尿失禁的男性患者，我们采用男性压力性尿失禁分级量表（Male Stress Incontinence Grading Scale，MSIGS）记录门诊站立咳嗽试验（standing cough test，SCT）结果，以此判断病情升级的发生率。同时计算了MSIGS评分与吊带手术成功率的相关性。手术失败定义为每日尿垫使用量＞1片，或需接受额外的尿失禁手术。
结果：在233名自我报告为中度压力性尿失禁（每日尿垫使用量2~3片）的患者中，有89名（38%）在SCT检查中MSIGS评分为3~4分，提示为重度压力性尿失禁。在术前每日尿垫使用量为2~3片的患者中，MSIGS评分为0~2分者的吊带手术成功率显著高于评分为3~4分者：前者成功率为64%（76/116），后者为33%（6/18）（p＜0.01）。
结论：许多自我报告为中度压力性尿失禁的男性患者，在站立咳嗽试验中实际被诊断为重度压力性尿失禁。站立咳嗽试验可有效对中度压力性尿失禁患者进行分层，从而更准确地预测吊带手术的成功率。