女性膀胱出口梗阻国际尿控学会诊断标准与排尿过程能量消耗曲线的比较研究

Comparative Study on ICS Diagnostic Criteria of Female Bladder Outlet Obstruction and Voiding Energy Lose Cure

目的:评估国际尿控学会(ICS)1998、2000、2004年标准在诊断女性膀胱出口梗阻(FBOO)中诊断的价值,比较排尿过程能量消耗曲线(VELC)及参数最小能量损耗比(minELR)和最大尿流率(Q_(max))时的女性能量损耗系数(FVELI_(Qmax))与ICS标准的差异。方法:通过女性下尿路症状评分(FLUTSSS)、尿动力学检查和VELC,从171例下尿路症状患者中筛选出54例经膀胱镜检查有膀胱颈明显梗阻的患者,行经尿道膀胱颈电切手术,并于电切术后3个月和1年复查FLUTSSS、尿动力学和VELC,以术前情况为有FBOO,以术后3个月和1年情况为无FBOO,评估ICS 1998、2000、2004年FBOO诊断标准的灵敏度和特异度。求minELR和FVELI_(Qmax)在诊断FBOO的CUT-OFF值和他们的灵敏度和特异度。结果:术后3个月与1年患者的FLUTSSS、生活质量评分(QOL)和Qmax明显改善。在本组中,以ICS 1998年标准诊断FBOO的灵敏度为68.5%,特异度为62.0%;以2000年标准诊断FBOO的灵敏度为29.6%,特异度为88.9%;以2004年标准诊断FBOO的灵敏度为27.8%,特异度为89.8%。minELR诊断FBOO的CUT-OFF值为≥80%,其灵敏度和特异度均为96.3%。FVELI_(Qmax)诊断FBOO的CUT-OFF值为≥9.5,其灵敏度为75.9%,特异度为69.4%。结论:在ICS的三个标准中以1998年标准较好,其灵敏度为68.5%,特异度为62.0%。而2000和2004标准虽然特异度有所提高,但灵敏度均低于30%。VELC诊断FBOO时曲线形态上表现为下斜坡型曲线,VELC的参数minELR和FVELI_(Qmax)在诊断FBOO时有良好的价值,其中minELR有较高的灵敏度和特异度。FVELI_(Qmax)在灵敏度和特异度方面均高于ICS的1998年标准。VELC在诊断FBOO方面可能优于现有的尿动力学手段。

Objective：To estimate the value of international continence socity （ICS） 1998,2000,2004 female bladder outlet obstruction （FBOO） diagnostic criteria. And to compare the differences of ICS 19982000, 2004 FBOO diagnosis standard between voiding energy lose curve（VELC）, their parameters of minimum energy lose ratio （minELR） and female voiding energy lose index of the maximum urine flow rate （FVELIQmax）. Methods.. 171 cases female lower urinary tract symptoms（FLUTS） had been evalueted by female lower urinary tract symptoms score scale（FLUTSSS）, quality of life（QOL）, urodynarnies and voiding energy lose curve （VELC）. 54 cases were FBOO, and confirmed bladder neck elevation by cystoscope. They had been operated transurethral resection of bladder neck. After three months and one year of transurethral resection of the bladder neck, they had been evaluated by FLUTSSS, QOL, urodynarnics and VELC. Preoperative condition was FBOO, the condition after three months and one year of surgery was non--FBOO. The sensitivity and specificity of ICS 1998,2000,2004 FBOO diagnostic criteria had been evalueted. The CUT-OFF value of rninELR and FVELIQmax and the sensitivity and specificity of FBOO diagnosis had been deterrninated. Results.. After three months and one year of transurethral resection of the bladder neck, their FLUTSSS, QOL and free the maximum flow rate had been improved significantly. The sensitivity of ICS 1998 diagnosis FBOO standard was 68.5 % and its specificity was 62.0%. The sensitivity of ICS 2000 diagnosis FBOO standard was 29.6% and its specificity was 88.9%. The sensitivity of ICS 2004 diagnosis FBOO standard was 27.8%0 and its specificity was 89.8%. minELR CUT-OFF value of FBOO were≥80%, and the sensitivity and specificity were 96.3%. FVELIQmax CUT-OFF value of FBOO were≥9.5, the sensitivity was 75.9 %, and specificity was 69.4 %. Conclusions： From three diagnostic criteria of ICS, ICS 1998 criteria was the best. Its sensitivity was 68.5%, and specificity was 62.0%. ICS 2000 and 2004 criteria had been improved, but its sensitivity were below 30%. VELC had a good diagnostic value on FBOO, the curve shape of VELC were lower slopes curves, minEI.R and FVELIQmax had a good value on FBOO diagnosis, and they had a good sensitivity and specificity. Sensitivity and specificity of FVELIQmax on FBOO diagnosis had been better than ICS 1998 standard. VELC and its parameters minELR and FVELIQnax had a better value than general urodynamic.