A systematic review included 40 studies. The gold standard was urodynamic examination, expert (urologist or urogynecologist) assessment, or both. Simple questions were helpful in diagnosing urge incontinence (summary positive LR 4.2, 95% CI 2.3 to 7.6, summary negative LR 0.48, 95% CI 0.36 to 0.62), and modestly helpful in diagnosing stress urinary incontinence (summary positive LR 2.2, 95% CI 1.6 to 3.2), summary negative LR 0.39, 95% CI 0.25 to 0.61). A positive bladder stress test was helpful in diagnosing stress urinary incontinence (summary positive LR 3.1, 95% CI 1.7 to 5.5; 5 trials, n=660), but a negative test is less useful (summary negative LR 0.36, 95% CI 0.21 to 0.60). A systematic assessment combining the history, physical examination, and results of bedside tests to establish a clinical diagnosis appears to be of modest value in diagnosing stress urinary incontinence (summary positive LR, 3.7; 95% CI, 2.6-5.2; summary negative LR, 0.20; 95% CI, 0.08-0.51).
A prospective observational study involved 50 women between the ages of 28 and 78 years with primary complaints of urinary incontinence. All subjects underwent a pelvic examination, cystometrogram, and a cough stress test (in the standing position at a bladder volume of 300 mL or at maximum cystometric capacity if it was less than 300 mL). Another similar cough stress test was performed 1 - 4 weeks later. 45 women (90%) had similar results with both tests. 35 had a positive cough stress test on the initial examination, and 32 of these patients (91%) also had a positive cough stress test at a repeat visit. 15 patients had a negative initial cough stress test, and 13 of these 15 (87%) had a negative cough stress test on repeat examination. All 20 patients diagnosed as having pure genuine stress incontinence had a positive cough stress test on initial and repeat examinations.
Date of latest search: 2010-10-24