Which factors improve diagnostic accuracy of urinary incontinence?

Updated: Sep 23, 2019
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

The more difficult question to answer is which battery of tests and examinations produces a high positive predictive value at the lowest cost and inconvenience to the patient. One study demonstrated the benefit of combining the following 4 factors to improve diagnostic accuracy:

  • Predominant stress incontinence history

  • Postvoid residual (PVR) volume of no more than 50 mL

  • Positive cough stress test

  • Functional bladder capacity of at least 400 mL

Complex urodynamic testing in patients with these factors confirmed the diagnosis of stress incontinence 97% of the time; however, 15% of these patients also had coexisting detrusor instability. The positive predictive value, if one considers mixed incontinence as a separate disorder, is 82%.

The essential issue seems to be the diagnosis of detrusor instability as a part of a mixed incontinence disorder. Therefore, adding cystometry to the battery of necessary tests seems logical in most instances.


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