否能用尿液生物標誌物於應力性尿失禁女性中辨認逼尿肌過動?

陳維心、江元宏、張嘉峰、郭漢崇

花蓮慈濟醫院 泌尿科

Can We Use Urinary Biomarkers to Identify Occult Detrusor Overactivity in Women with Stress Urinary Incontinence?

Wei-Hsin Chen, Yuan-Hong Jiang, Jia-Fong Jhang, Hann-Chorng Kuo

Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan

Purpose: To evaluate urine biomarkers that could be used to identify occult detrusor overactivity in women with stress urinary incontinence and frequency urgency symptoms.

Materials and Methods: We retrospectively enrolled 93 women who were diagnosed with intrinsic sphincter deficiency (ISD) under video urodynamic study (VUDS) and had urine samples collected before the sling operation from 2018 to 2021. According to the diagnosis of the VUDS, the patients were categorized into three groups: detrusor overactivity (DO) and ISD, hypersensitive bladder (HSB) and ISD, and stable bladder and ISD. To investigate urine biomarkers, we used the MILLIPLEX^® human cytokines/chemokines, adipokine, and neurodegenerative disease magnetic bead panels, Luminex^® 200™, and xPONENT^® software. Urodynamic parameters and urine biomarkers were analyzed in these three groups.

Results: The mean age was 60.8±10.7 (36-83) years. Thirty-one (33.3%) patients were in the group of DO and ISD, 28 (30.1%) had HSB and ISD, and 34 (36.6%) had stable bladder and ISD (controls). Compared with controls, patients with DO and ISD had significantly increased detrusor pressure at maximal urinary flow (Pdet), and significantly decreased maximum flow rate (Qmax), voided volume (vol), first sensation (FS), first sensation of filling (FSF), compliance, bladder contractility index (BCI), and cystometric bladder capacity (CBC). Compared with control, patients with DO and ISD had significantly increased urine interleukin-1β (median 0.74 v.s. 0.56 pg/dL, p = 0.043), increased urine 8-isoprostane (median 19.09 v.s. 6.53 pg/dL, p = 0.014), decreased urine interleukin-2 (median 0.36 v.s. 0.62 pg/dL, p = 0.021), and decreased urine VEGF (median 3.2 v.s. 8.1 pg/dL, p = 0.015). Increased urine 8-isoprostane was a significant predictor of DO in patients with ISD (HR 1.04, 95% CI 1.001-1.071, p = 0.032). With the cutoff point being 12.01 pg/dL, the specificity of urine 8-isoprostane is over 70% with the area under curve being over 0.7 (p=0.0046).

Conclusions: Urine 8-isoprostane was significantly elevated in patients with DO and ISD than patients with stable bladder and ISD.  It has the potential to be used to identify occult detrusor overactivity in patients with stress urinary incontinence.