Although the symptom complex alone is unreliable in the diagnosis of stress incontinence, a full urodynamic assessment may be distressing for patients and may cost more than $4,000. Videla and Wall conducted a retrospective chart review to evaluate the correlation between clinical findings and multi-channel urodynamic testing to determine if simple criteria could be used to make a diagnosis of stress urinary incontinence.
The authors reviewed the charts of 652 women who presented for evaluation of symptoms suggestive of pelvic organ prolapse and urinary tract dysfunction. Four criteria were used to make a diagnosis of stress incontinence: urine loss during episodes of raised intra-abdominal pressure (sneezing, coughing or exercising); positive cough stress-test (observed spurt of urine on coughing); post-voiding residual bladder capacity of up to 50 mL; and functional bladder capacity of at least 400 mL. Women who met the criteria then underwent provocative multichannel urodynamic testing to confirm the diagnosis.
Of the 74 women who fulfilled these four criteria, 72 (97 percent) had stress incontinence demonstrated by urodynamic testing. One patient had normal test results, and one had uninhibited detrusor contractions.
The authors conclude that simple criteria based on history and clinical assessment are highly reliable in the diagnosis of stress urinary incontinence. They suggest that the role of complex urodynamic testing be re-examined.