PROPER DIAGNOSIS - A MUST BEFORE SURGERY FOR STRESS-INCONTINENCE

Stress urinary incontinence is just one of many possible reasons for i ncontinence in a female patient. It is important to determine the exac t etiology of the urinary incontinence because successful treatment de pends on an accurate diagnosis. Many additional factors such as age, l evel of activity, presence and degree of pelvic prolapse, detrusor abn ormalities, and coexisting medical conditions must be considered durin g the incontinence evaluation. The physical examination should assess urethral mobility and genital prolapse abnormalities. Bladder storage abnormalities such as poor compliance are accurately assessed using cu rrent urodynamic methods, but detrusor control abnormalities, such as detrusor instability, are not. The urodynamic evaluation is directed t oward identifying and quantifying urinary leakage attributable to excu rsions of abdominal pressure utilizing abdominal (Valsalva) leak-point pressure testing. A focused evaluation allows the appropriate operati ve procedure to be selected, yielding optimal long-term results.