Determining the Type of Urinary Incontinence on the Basis of Bladder Stress Test

Summary

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 was helpful in diagnosing stress urinary incontinence (summary positive LR 3.1, 95% CI 1.7 to 5.5; 5 trials, n=660), but a negative test is less useful (summary negative LR 0.36, 95% CI 0.21 to 0.60). A systematic assessment combining the history, physical examination, and results of bedside tests to establish a clinical diagnosis appears to be of modest value in diagnosing stress urinary incontinence (summary positive LR, 3.7; 95% CI, 2.6-5.2; summary negative LR, 0.20; 95% CI, 0.08-0.51).

A prospective observational study 2 involved 50 women between the ages of 28 and 78 years with primary complaints of urinary incontinence. All subjects underwent a pelvic examination, cystometrogram, and a cough stress test (in the standing position at a bladder volume of 300 mL or at maximum cystometric capacity if it was less than 300 mL). Another similar cough stress test was performed 1 - 4 weeks later. 45 women (90%) had similar results with both tests. 35 had a positive cough stress test on the initial examination, and 32 of these patients (91%) also had a positive cough stress test at a repeat visit. 15 patients had a negative initial cough stress test, and 13 of these 15 (87%) had a negative cough stress test on repeat examination. All 20 patients diagnosed as having pure genuine stress incontinence had a positive cough stress test on initial and repeat examinations.