THE ROLE OF PATIENT HISTORY IN THE DIAGNOSIS OF URINARY-INCONTINENCE

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.