Evaluation of Uncomplicated Urinary Incontinence
A 38-year-old woman comes in with a history of urinary incontinence. During the physical examination, she leaked urine while coughing. Her pelvic examination is normal, except for a swab test that shows a 40-degree change. Urinalysis is entirely normal. Her medical and surgical histories are not significant.
- Bladder diary
- Postvoid residual
- No additional steps required
According to the American Urological Association guidelines which are adopted by most other societies Physicians should include the following components in the initial evaluation of patients with Uncomplicated stress urinary incontinence who want to undergo surgical intervention:
- History, including an evaluation of the hindrance
- A physical examination, including a pelvic examination
- Objective demonstration of stress urinary incontinence with a comfortably full bladder
- Evaluation of post-void residual urine
A bladder diary can be useful in patients who report urinary incontinence and is frequently encouraged as part of conservative management prior to deciding on a surgical procedure that could reveal excessive fluid intake, drinking just before the time of maximal incontinence, or reasoning for nocturia or polyuria. Although keeping a diary is encouraged, it is not required in patients with uncomplicated urinary incontinence before surgery because it rarely changes the patient’s treatment or outcome.
Cystoscopy should be performed only as needed in patients with suspected bladder pathology based on history or concerning findings on physical examination or urinalysis. Cystoscopy should be performed in patients who have microhaematuria on urinalysis also on patients who have structural lower urinary tract abnormalities in addition to patients who have had prior anti-incontinence surgery or pelvic floor reconstruction, especially if mesh or suture perforation is suspected.
Urodynamic testing is not required in otherwise healthy patients during the initial patient assessment or to determine outcomes following surgery. The Value of Urodynamic Evaluation (VALUE) trial15 evaluated the role of urodynamics in patients with uncomplicated SUI (pure SUI or stress-predominant MUI) undergoing surgery and found no difference in outcomes as measured by clinical reduction in complaints measured by the Urinary Distress Inventory and the Patient Global Impression of Improvement
- Kobashi KC, Albo ME, Dmochowski RR et al: Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline. J Urol 2017; 198: 875.
- National Institute for Health and Care Excellence. (2019). Urinary incontinence and pelvic organ prolapse in women: management. [NICE guideline NG123]. nice.org.uk/guidance/ng123
- Raza-Khan, F. (2021). Basic Evaluation of Urinary Incontinence. Clinical Obstetrics and Gynecology, 64(2), 276-286.
- Sharma, N., & Chakrabarti, S. (2018). Clinical Evaluation of Urinary Incontinence. Journal of mid-life health, 9(2), 55–64. https://doi.org/10.4103/jmh.JMH_122_17