目的:探讨基于无创检查结果的新型临床诊断标准对男性尿动力逼尿肌活动不足(DU)的诊断价值。
方法:我们制定了临床诊断标准来预测男性尿动力学DU的存在如下:(a)膀胱排尿效率<70%,(b)尿流仪上存在“锯齿和中断波形”,和(c)超声检查记录的膀胱内前列腺突出<10mm。我们分析了敏感性,特异性,阳性预测值(PPV),这些临床标准诊断尿动力学DU的阴性预测值(NPV)在50岁或以上患有下尿路症状并接受尿动力学研究的男性中。
结果:在分析的314名男性中(平均年龄,72.4年;逼尿肌平均收缩指数[DCI],98.8;和平均膀胱出口梗阻指数[BOOI],43.9),89名男性符合该临床DU诊断标准。其中,79名男性(88.8%)患有尿动力学DU(DCI<100和BOOI<40),9人(10.1%)有DU+BOO(DCI<100,BOOI≥40),1人(1.1%)的排尿功能正常。尿动力学BOO(DCI≥100和BOOI≥40)的男性均不符合临床DU诊断标准。敏感性,特异性,PPV,这些临床诊断标准的尿动力学DU的NPV为69.3%,95.0%,88.8%,和84.4%,分别。
结论:拟议的临床DU诊断标准显示用于诊断尿动力学DU的高PPV(88.8%)。BOO患者均不符合DU的临床诊断标准。这些临床DU诊断标准可能有助于在临床实践中识别患有尿动力学DU的男性。
OBJECTIVE: To investigate the usefulness of novel clinical diagnostic criteria based on noninvasive examination findings to diagnose urodynamic detrusor underactivity (DU) in men.
METHODS: We developed clinical diagnostic criteria to predict the presence of urodynamic DU in men as follows: (a) bladder voiding efficiency <70% on uroflowmetry, (b) existence of \"sawtooth and interrupted waveforms\" on uroflowmetry, and (c) ultrasonography-documented intravesical prostatic protrusion <10 mm. We analyzed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these clinical criteria for diagnosing urodynamic DU in men aged 50 years or above with lower urinary tract symptoms who underwent urodynamic studies.
RESULTS: Of the 314 men analyzed (mean age, 72.4 years; mean detrusor contraction index [DCI], 98.8; and mean bladder outlet obstruction index [BOOI], 43.9), 89 men met this clinical DU diagnostic criteria. Of these, 79 men (88.8%) had urodynamic DU (DCI < 100 and BOOI < 40), nine (10.1%) had DU + BOO (DCI < 100 and BOOI ≥ 40), and one (1.1%) had normal voiding functions. None of the men with urodynamic BOO (DCI ≥ 100 and BOOI ≥ 40) met the clinical DU diagnostic criteria. The sensitivity, specificity, PPV, and NPV of these clinical diagnostic criteria for urodynamic DU were 69.3%, 95.0%, 88.8%, and 84.4%, respectively.
CONCLUSIONS: The proposed clinical DU diagnostic criteria showed a high PPV (88.8%) for diagnosing urodynamic DU. None of the patients with BOO met the clinical diagnostic criteria for DU. These clinical DU diagnostic criteria may be useful in identifying men with urodynamic DU in clinical practice.