Микционата цистометрија во дијагностичката проценка на уринарната инконтиненција кај жената

Abstract

Urinary incontinence represents involuntary leakage of urine, which is a hygienic and/or social problem of the individual and can be objectively demonstrated as a symptom and/or a sign. The etiology is varied, unspecific and multifactorial. Among the types of transurethral urinary incontinence, urinary stress incontinence and urgent (imperative) urinary incontinence are of special interest in urogynecology. Voiding, as a process, requires coordination of several physiological processes, and urinary incontinence, as involuntary voiding, represents a disturbance or deviation from those processes. Their location is the key to a successful diagnosis which can lead to a correct and successful therapy. Urodynamics is used as a golden standard, without which practically every urinary incontinence diagnosis would be insufficient. The part of urodynamics which analyses the evacuation of urine from the bladder is called voiding cystometry (i.e. pressure/flow studies in the western literature). Voiding cystometry is a rich source of data regarding the function of the bladder, but without visible, evident results which can be transformed into parameters for defining urinary incontinence subtypes, or into indicators for prognosis and/or success of the therapeutical procedures. Two hundred and ninety four patients were analyzed, aged 36-69 years, out of which 104 with urinary stress incontinence, 100 with detrusor instability and a control group of 90 women without incontinence. The patients were given the standard diagnostical procedure in evaluation of urinary incontinence, according to the urinary incontinence evaluation protocol of the University clinic of gynecology and obstetrics in Skopje. The patients were given a standard questionnaire with a sample of 15 questions, in understandable language with given answers which only need be circled. The answers were given without pressure, a time limit or suggestions. Uncertainties were resolvedthrough a direct interview with the doctor. In order to implement voiding cystometry, the patients were placed over a voiding collector in a seated position, with a measuring catheter in the bladder, after which the patients were asked to completely void the bladder of the previously filled liquid. During the voiding, the parameters of voiding cystometry were measured and later processed with standard statistical methods and procedures for processing and comparing strings of numbers and also with statistical tools for qualitative and descriptive statistical analysis. The results showed statistically significant differences in the parameters initial voiding pressure (30,7 vs 36,85 cm H2O), peak flow pressure (30,44 vs 39,84 cm H2O), peak flow (22,09 vs 28,31 ml/s), mean flow (11,29 vs 13,84 ml/s), voiding duration (39,08 vs 28,56 s). The parameter bladder effect was especially highlighted in both analysed variants, maximal-BЕmax (64,36 vs 108,54 mW) and average-BEav (31,85 vs 50,56 mW). The analysis of the anamnestic questionnaires showed a distribution of answers which was largely repetitive. It was perceived that the questionnaire was seen as some test that needed to be “passed” in order to reach a goal i.e. the treatment which was desired or anticipated as a solution to the patient’s problem. The conclusions from the study emphasize the bladder effect, in both variants, as a new diagnostical urodynamic parameter which could help in differentiating between urinary incontinence subtypes, i.e. urinary stress incontinence and detrusor instabilis, while voiding cystometry might become a useful tool in the struggle to achieve the correct diagnosis of urinary incontinence.