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这位患有下尿道症状的人是否有膀出口阻塞? :理性的临床检查:一个系统的审查
Karen A D'Silva1, Philipp Dahm2, Camilla L Wong3
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada2Division of Geriatrics, St Michael's Hospital, Toronto, Ontario, Canada.
JAMA
|August 7, 2014
概括
仅仅症状不足以诊断男性的膀出口阻塞. 建议进行膀扫描,以准确测量余空后的残留体积,有助于诊断和管理下尿路症状.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 诊断的准确性 诊断的准确性
- 医疗技术 医疗技术 医学技术
背景情况:
- 男性下泌尿道症状 (LUTS) 可能表明膀出口阻塞 (BOO).
- 早期诊断BOO至关重要,以避免侵入性测试和有效管理症状.
- 精确测量后空余 (PVR) 尿量对于BOO评估至关重要.
研究的目的:
- 系统地审查办公室测试的诊断准确性,以检测LUTS男性的BOO.
- 为了评估膀扫描在测量尿液体积的准确性,与 катетеризация相比.
主要方法:
- 对MEDLINE,EMBASE和科克兰图书馆数据库的系统审查 (1950年至2014年3月).
- 包括前性研究,将非侵入性诊断测试或膀扫描与参考标准 (尿动力学或导管) 进行比较.
- 分析了症状/问卷的诊断准确性和膀扫描与PVR体积的导管治疗的相关性.
主要成果:
- 个体症状和问卷显示BOO的诊断准确性有限 (概率比包括1.0).
- 国际前列腺症状评分 (IPSS) ≥20增加了BOO的可能性 (LR+,1.5),但得分<20是不确定的 (LR-,0.82).
- 膀扫描显示了与膀导管测量尿量 (r=0.93) 的高相关性.
结论:
- 仅仅通过症状和问卷,就不足以在患有LUTS的男性中诊断BOO.
- 膀扫描对于测量PVR尿量是准确的,应用于评估.
- 通过膀扫描精确的PVR测量可以指导管理,并可能减少侵入性手术.
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