Urodinâmica convencional versus cistometria simplificada para caracterização da incontinência urinária feminina
Data
2004-05-01
Autores
Kawano, Paulo Roberto [UNESP]
Amaro, João Luiz [UNESP]
Scarpa e Silva, Fábio [UNESP]
Agostinho, Aparecido Donizeti [UNESP]
Yamamoto, Hamilto Akihissa [UNESP]
Trindade, José Carlos Souza [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Federação Brasileira das Sociedades de Ginecologia e Obstetrícia
Resumo
OBJETIVO: avaliar a concordância dos diferentes parâmetros urodinâmicos comparados à cistometria simplificada, permitindo uma diminuição na relação custo-benefício no diagnóstico da incontinência urinária de esforço (IUE) na mulher. MÉTODOS: foram coletadas e avaliadas retrospectivamente as informações contidas dos prontuários de trinta pacientes acompanhadas, no período de janeiro de 2000 a março de 2001. Todas foram submetidas a exame físico geral e ginecológico. O estudo urodinâmico foi realizado pela técnica convencional, utilizando-se aparelho Dynograph Recorder R-611. A cistometria simplificada foi realizada com auxílio de um equipo em Y de PVC (pressão venosa central), conectado a um sonda de Foley 14 F, que permitia tanto a infusão de soro fisiológico como a captação da pressão intra-vesical. Foram analisados os parâmetros: volume residual, capacidade vesical, complacência, presença de contrações involuntárias do detrusor e perdas urinárias aos esforços. Para determinação da proporção de concordância entre os métodos foram utilizados o teste de concordância de Pearson e o teste de Wilcoxon, para amostras relacionadas. RESULTADOS: a média de idade foi de 50 anos, com extremos variando de 28 a 70 anos. O índice de concordância entre os estudos, na demonstração das perdas urinárias aos esforços, foi de 67%. Para a detecção das contrações involuntárias do detrusor, a proporção de concordância foi de 90%. A média do volume residual encontrado na cistometria simplificada foi de 16,8 ml contra 2 ml da urodinâmica convencional, com diferença significativa (p < 0,01). A média de capacidade vesical máxima no estudo urodinâmico foi de 440,5 ml, enquanto que, na cistometria simplificada, foi de 387 ml (p < 0,05). A complacência vesical foi, em média, significativamente maior na cistometria simplificada (43,0 ml/cmH2O) quando comparada ao estudo urodinâmico (31,5 ml/cmH2O), com p < 0,01. CONCLUSÃO: Avaliações preliminares sugerem que a propedêutica uroginecológica associada à cistometria simplificada é uma opção a ser considerada na avaliação clínica e pré-operatória de pacientes com IUE em substituição à urodinâmica convencional, particularmente onde esta última não se encontra disponível. A cistometria simplificada é um exame acessível que é capaz de detectar contrações involuntárias do detrusor, assim como identificar perdas urinárias com relativa sensibilidade, proporcionando ao examinador noções fidedignas do comportamento vesical.
OBJECTIVE: to assess the concordance of different urodynamic parameters with simplified cystometry, thus improving the cost-benefit relationship for stress urinary incontinence (SUI) diagnosis in woman. METHODS: we evaluated retrospectively the medical records of thirty patients treated, from January 2000 to March 2001. All patients had been submitted to physical and gynecological examinations. A conventional urodynamic study had been made using a Dynograph R-611 recorder. Simplified cystometry had used a saline tube with Y connector, connected to a Foley 14 Fr catheter, which allowed measurement of intra-vesical pressure at the same time as physiological saline infusion. The following parameters were analyzed: residual volume, bladder capacity, complacency, involuntary detrusor contractions, and abdominal leak-point pressure. The Pearson test of agreement and the Wilcoxon signed rank test were used to verify the concordance between related samples, with p < 0,05. RESULTS: the average age was 50 years old (28-70). Concordance between studies for stress urinary losses was 67%, and for detrusor involuntary contractions, 90%. The average residual volume was significantly different: by simplified cystometry it was 16.8 ml versus 2 ml by conventional urodynamics (p < 0.01). The average maximum vesical capacity by urodynamic study was 440.5 ml, and by simplified cystometry, 387 ml (p < 0.05). Vesical complacency was on average, significantly larger in simplified cystometry (43.0 ml/cmH2O) than in the urodynamic study (31.5 ml/cmH2O), with p < 0.01. CONCLUSION: preliminary evaluations suggest that the urogynecologic propedeutic associated with cystometry is an option to be considered in the clinical and preoperative assessment of patients with SUI instead of conventional urodynamics, particularly when the latter is not available. Simplified cystometry is an accessible exam that grants comparable results for the detection of involuntary detrusor contractions and for the identification of urinary loss, providing the examiner with trustworthy data on vesical behavior.
OBJECTIVE: to assess the concordance of different urodynamic parameters with simplified cystometry, thus improving the cost-benefit relationship for stress urinary incontinence (SUI) diagnosis in woman. METHODS: we evaluated retrospectively the medical records of thirty patients treated, from January 2000 to March 2001. All patients had been submitted to physical and gynecological examinations. A conventional urodynamic study had been made using a Dynograph R-611 recorder. Simplified cystometry had used a saline tube with Y connector, connected to a Foley 14 Fr catheter, which allowed measurement of intra-vesical pressure at the same time as physiological saline infusion. The following parameters were analyzed: residual volume, bladder capacity, complacency, involuntary detrusor contractions, and abdominal leak-point pressure. The Pearson test of agreement and the Wilcoxon signed rank test were used to verify the concordance between related samples, with p < 0,05. RESULTS: the average age was 50 years old (28-70). Concordance between studies for stress urinary losses was 67%, and for detrusor involuntary contractions, 90%. The average residual volume was significantly different: by simplified cystometry it was 16.8 ml versus 2 ml by conventional urodynamics (p < 0.01). The average maximum vesical capacity by urodynamic study was 440.5 ml, and by simplified cystometry, 387 ml (p < 0.05). Vesical complacency was on average, significantly larger in simplified cystometry (43.0 ml/cmH2O) than in the urodynamic study (31.5 ml/cmH2O), with p < 0.01. CONCLUSION: preliminary evaluations suggest that the urogynecologic propedeutic associated with cystometry is an option to be considered in the clinical and preoperative assessment of patients with SUI instead of conventional urodynamics, particularly when the latter is not available. Simplified cystometry is an accessible exam that grants comparable results for the detection of involuntary detrusor contractions and for the identification of urinary loss, providing the examiner with trustworthy data on vesical behavior.
Descrição
Palavras-chave
Cistometria simplificada, Estudo urodinâmico, Incontinência urinária, Simplified cystometry, Urodynamic study, Urinary incontinence
Como citar
Revista Brasileira de Ginecologia e Obstetrícia. Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, v. 26, n. 4, p. 311-316, 2004.