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The Sign Of Stress Incontinence ‐ Should We Believe What We See?
Published 1997 · Medicine
EDITORIAL COMMENT: This paper provides information about the reliability of clinical symptoms and signs of urinary stress incontinence in comparison with the final diagnosis arrived at with the combination of multichannel cystometrography and urethral pressure profilometry. While these specialized investigations do provide more detailed information about bladder and urethral function than is available clinically, no published research supports a need for cystometric testing in routine or basic‐evaluation of urinary incontinence. The Agency for Health Care Policy and Research in a review of the management of urinary incontinence in adults (A) does not recommend urodynamic investigation in women with stress incontinence prior to initial surgery if there are no complicating factors, the postvoiding volume is normal and the stress incontinence is associated with bladder neck hypermobility and is nonrecurrent. This study has shown that urodynamic investigation identified a large proportion of women with urinary symptoms who in addition to true stress incontinence have other urinary problems that warrant conservative management. However, conservative treatment can also be successful in women with genuine stress incontinence as the only urodynamic abnormality. Moreover, surgical treatment maybe unsuccessful when the only urinary problem is genuine stress incontinence, and successful in women with additional urodynamic problems to that of genuine stress incontinence. It remains a difficult clinical problem to decide when surgery is indicated in women with mixed urinary symptoms and/or urodynamic findings of dual pathology.