OBJECTIVE: To estimate the reliability and interobserver consistency of urodynamic interpretations of female bladder and urethral function. METHODS: Three urogynecologists and three female urologists at a tertiary car...OBJECTIVE: To estimate the reliability and interobserver consistency of urodynamic interpretations of female bladder and urethral function. METHODS: Three urogynecologists and three female urologists at a tertiary caremedical center reviewed masked, abstracted clinical and urodynamic information from 100 charts, selected for adequate completeness from a consecutive series of 135 women referred for urodynamic testing. For each of the 100 cases, the reviewers assigned InternationalContinence Society filling and voiding phase diagnoses, and overall clinical diagnoses. Raw agreement proportions and weighted kappa chance- corrected agreement statistics (κ ) were used jointly to describe both reliability and interobserver agreement. Reliability was estimated from duplicate reviews, masked and separated by at least 4 months, of each case by each physician. Interobserver agreement was estimated from comparisons of all pairs of responses from different physicians. RESULTS: For clinical diagnosis of stress incontinence (present, absent, indeterminate), the within- and across- physician weighted κ ’s were, respectively, 0.78 and 0.68. Corresponding results were 0.40 and 0.13 for detrusor overactivity without incontinence, 0.58 and 0.38 for detrusor overactivity with incontinence, and 0.51 and 0.26 for voiding dysfunction. Standard errors of each κ were between 0.023 and 0.043. CONCLUSION: In our group, lower urinary tract diagnoses of stress urinary incontinence from both clinical and urodynamic data demonstrated substantial reliability and interobserver agreement. However, by conventional interpretation of κ - statistics, reliability of diagnoses of detrusor overactivity or voiding dysfunction was onlymoderate, and interobserver agreement on these diagnoses was no better than fair. Urodynamic interpretations may not be satisfactorily reproducible for these diagnoses.展开更多
The purpose of this study was to determine factors that are associated with recurrent prolapse. Of 389 women who underwent vaginal prolapse and incontinence between June 1996 and May 1999, 176 women had 1-year follow...The purpose of this study was to determine factors that are associated with recurrent prolapse. Of 389 women who underwent vaginal prolapse and incontinence between June 1996 and May 1999, 176 women had 1-year followup evaluations. Recurrent prolapse was analyzed by both pelvic organ prolapse quantification stage and centimeter measurements that were relative to the hymen. Logistic regression was used to determine odds ratios and 95%CI for factors that were associated with recurrent prolapse. One year after surgery, 102 women (58%) had recurrent prolapse (≥stage II). Seventeen women (10%) had prolapse ≥1 cm beyond the hymen. Age <60 years (odds ratio, 3.2; 95%CI, 1.6-6.4; P =. 001) and preoperative pelvic organ prolapse quantification stage III or IV (odds ratio, 2.7; 95%CI, 1.3-5.3; P =. 005) were associated with a greater likelihood of recurrent prolapse (≥stage II) at 1 year. Younger women and women with more advanced prolapse are more likely to experience recurrent prolapse after vaginal repair.展开更多
文摘OBJECTIVE: To estimate the reliability and interobserver consistency of urodynamic interpretations of female bladder and urethral function. METHODS: Three urogynecologists and three female urologists at a tertiary caremedical center reviewed masked, abstracted clinical and urodynamic information from 100 charts, selected for adequate completeness from a consecutive series of 135 women referred for urodynamic testing. For each of the 100 cases, the reviewers assigned InternationalContinence Society filling and voiding phase diagnoses, and overall clinical diagnoses. Raw agreement proportions and weighted kappa chance- corrected agreement statistics (κ ) were used jointly to describe both reliability and interobserver agreement. Reliability was estimated from duplicate reviews, masked and separated by at least 4 months, of each case by each physician. Interobserver agreement was estimated from comparisons of all pairs of responses from different physicians. RESULTS: For clinical diagnosis of stress incontinence (present, absent, indeterminate), the within- and across- physician weighted κ ’s were, respectively, 0.78 and 0.68. Corresponding results were 0.40 and 0.13 for detrusor overactivity without incontinence, 0.58 and 0.38 for detrusor overactivity with incontinence, and 0.51 and 0.26 for voiding dysfunction. Standard errors of each κ were between 0.023 and 0.043. CONCLUSION: In our group, lower urinary tract diagnoses of stress urinary incontinence from both clinical and urodynamic data demonstrated substantial reliability and interobserver agreement. However, by conventional interpretation of κ - statistics, reliability of diagnoses of detrusor overactivity or voiding dysfunction was onlymoderate, and interobserver agreement on these diagnoses was no better than fair. Urodynamic interpretations may not be satisfactorily reproducible for these diagnoses.
文摘The purpose of this study was to determine factors that are associated with recurrent prolapse. Of 389 women who underwent vaginal prolapse and incontinence between June 1996 and May 1999, 176 women had 1-year followup evaluations. Recurrent prolapse was analyzed by both pelvic organ prolapse quantification stage and centimeter measurements that were relative to the hymen. Logistic regression was used to determine odds ratios and 95%CI for factors that were associated with recurrent prolapse. One year after surgery, 102 women (58%) had recurrent prolapse (≥stage II). Seventeen women (10%) had prolapse ≥1 cm beyond the hymen. Age <60 years (odds ratio, 3.2; 95%CI, 1.6-6.4; P =. 001) and preoperative pelvic organ prolapse quantification stage III or IV (odds ratio, 2.7; 95%CI, 1.3-5.3; P =. 005) were associated with a greater likelihood of recurrent prolapse (≥stage II) at 1 year. Younger women and women with more advanced prolapse are more likely to experience recurrent prolapse after vaginal repair.
