STRESS-INCONTINENCE DIAGNOSED WITHOUT MULTICHANNEL URODYNAMIC STUDIES

Objective: To determine if the clinical diagnosis of stress urinary in continence made on the basis of simple criteria correlates with the di agnosis of genuine stress incontinence as determined by provocative mu ltichannel urodynamic testing. Methods: The charts of 652 women who pr esented for clinical evaluation of a variety of lower urinary tract co mplaints were reviewed if they met all of the following criteria: 1) a predominant complaint of stress incontinence, 2) positive cough stres s-test results, 3) postvoid residual urine volume no more than 50 mt, 4) a functional bladder capacity of at least 400 mi, as determined by a completed 24-hour frequency-volume chart, and 5) a full multichannel urodynamic evaluation. Seventy-four patients met all these criteria. The clinical diagnosis of stress incontinence was based on the presenc e of factors 1-4; this diagnosis then was compared with the results of provocative multichannel urodynamic testing. Results: Genuine stress incontinence was confirmed in 72 (97%) of 74 patients meeting the afor ementioned clinical criteria. In one patient, detrusor instability alo ne was demonstrated during urodynamic testing. In 11 patients with gen uine stress incontinence (15%), an element of detrusor instability was also present at the time of urodynamic testing. One patient had norma l urodynamic study findings, with no incontinence demonstrated. Conclu sion: Rigorously defined clinical criteria are highly reliable in pred icting the presence of genuine stress incontinence at the time of urod ynamic testing. Because of the potential implications of this finding for clinical practice, further investigation is warranted. (C) 1998 by The American College of Obstetricians and Gynecologists.