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Evidence summaries

Determining the Type of Urinary Incontinence on the Basis of History-Taking and Physical Examination

A history of loss of urine associated with urgency appears to be helpful in diagnosing urge urinary incontinence. Level of evidence: "B"

A systematic review 1 included 40 studies. The gold standard was urodynamic examination, expert (urologist or urogynecologist) assessment, or both. Simple questions were helpful in diagnosing urge incontinence (summary positive LR 4.2, 95% CI 2.3 to 7.6, summary negative LR 0.48, 95% CI 0.36 to 0.62), and modestly helpful in diagnosing stress urinary incontinence (summary positive LR 2.2, 95% CI 1.6 to 3.2), summary negative LR 0.39, 95% CI 0.25 to 0.61). A positive bladder stress test may help diagnose stress urinary incontinence (summary positive LR 3.1, 95% CI 1.7 to 5.5), but a negative test is less useful (summary negative LR 0.36, 95% CI 0.21 to 0.60).

Comment: The gold standard for diagnosing the type of urinary incontinence is not robust. The review did not address the coexistence of both types of incontinence.

    References

    • Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE. What type of urinary incontinence does this woman have? JAMA 2008;299(12):1446-56.

Primary/Secondary Keywords