Objective: To assess the clinical usefulness and validity of patient h
istory in the diagnosis of genuine stress incontinence and detrusor ov
eractivity. Data sources: A literature search was performed for public
ations addressing the clinical evaluation of urinary incontinence betw
een 1975-1992. Methods of study selection: Nineteen of 29 articles dur
ing this period reported data in such a manner as to allow statistical
comparison of patient history to the diagnosis based on urodynamic ev
aluation. Data extraction and synthesis: Each article was assessed for
the following information: inclusion and exclusion criteria, method o
f obtaining patient history, clinical evaluation, and diagnostic crite
ria. Patients in each article were classified according to their histo
ry and urodynamic diagnosis. Sensitivity, specificity, and predictive
values were calculated for each article, as well as for the combined d
ata from all articles. Combined data from all 19 articles produced a t
otal of 3092 and 2950 patients evaluated for genuine stress incontinen
ce and detrusor overactivity, respectively. A clinical history consist
ent with stress incontinence, when compared to a urodynamically based
diagnosis, showed;a sensitivity of 0.906, a specificity of 0.511, a po
sitive predictive value of 0.749, and a negative predictive value of 0
.771. A comparison of clinical history suggestive of an overactive det
rusor and urodynamic evidence of spontaneous bladder activity revealed
a sensitivity of 0.735, specificity of 0.552, positive predictive val
ue of 0.561, and negative predictive value of 0.728.Conclusion: Patien
t history alone is not an accurate tool in the diagnosis of genuine st
ress incontinence or detrusor overactivity, and should not be the sole
determinant of diagnosis or treatment.