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The Sign of Stress Incontinence ‐ Should We Believe What We See?
Author(s) -
Carey Marcus P.,
Dwyer Peter L.,
Glenning Peter P.
Publication year - 1997
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1997.tb02455.x
Subject(s) - sign (mathematics) , stress (linguistics) , stress incontinence , psychology , urinary incontinence , medicine , urology , mathematics , philosophy , linguistics , mathematical analysis
EDITORIAL COMMENT: This paper provides information about the reliability of clinical symptoms and signs of urinary stress incontinence in comparison with the final diagnosis arrived at with the combination of multichannel cystometrography and urethral pressure profilometry. While these specialized investigations do provide more detailed information about bladder and urethral function than is available clinically, no published research supports a need for cystometric testing in routine or basic‐evaluation of urinary incontinence. The Agency for Health Care Policy and Research in a review of the management of urinary incontinence in adults (A) does not recommend urodynamic investigation in women with stress incontinence prior to initial surgery if there are no complicating factors, the postvoiding volume is normal and the stress incontinence is associated with bladder neck hypermobility and is nonrecurrent. This study has shown that urodynamic investigation identified a large proportion of women with urinary symptoms who in addition to true stress incontinence have other urinary problems that warrant conservative management. However, conservative treatment can also be successful in women with genuine stress incontinence as the only urodynamic abnormality. Moreover, surgical treatment maybe unsuccessful when the only urinary problem is genuine stress incontinence, and successful in women with additional urodynamic problems to that of genuine stress incontinence. It remains a difficult clinical problem to decide when surgery is indicated in women with mixed urinary symptoms and/or urodynamic findings of dual pathology.(A). Fantl JA, Newman DK, Colling J et al. Urinary incontinence in adults: acute and chronic management. Clinical Practice Guidelines No. 2, 1996 Update. Rockville MD: U.S. Department of Health and Human Services, Public Health Agency. Agency for Health Care Policy and Research. AHCPR Publication No. 96–0682. March 1996.Summary: The accuracy of the clinical sign of stress incontinence in the diagnosis of genuine stress incontinence (GSI) was evaluated in 863 (consecutive) women. 779 of whom were referred with the symptom of urinary incontinence. Subjects were assessed clinically and urodynamically by the one clinician (PLD). The positive and negative predictive values of the clinical sign of stress incontinence for a diagnosis of GSI were 91% and 50% respectively. Of the 569 women with GSI. 335 (59%) had GSI as their sole diagnosis and 234 (41%) had an additional urodynamic diagnosis The clinical sign of stress incontinence when present was a reliable guide to a final diagnosis of GSI. Clinical assessment of incontinent women requires the back‐up of urodynamic studies in order to make an accurate diagnosis.