Clinical, Urodynamic and Ultrasound Study for the Evaluation of Urinary Incontinence Associated with Genital Prolapse

Abstract

Objectives: Comparing the accuracy of clinical assessment versus ultrasound and urodynamic study in detecting stress urinary incontinence associated with genital prolapse. Study design: A prospective study. Setting: Gynaecologic outpatient Clinic, Al-Elwiya Maternity Teaching Hospital, Baghdad –Iraq. Patients and methods: The study was conducted on 69 women with urinary incontinence associated with genital prolapse. Detailed history and clinical examination including complete bimanual pelvic examination, stress test, Bonney test and Q-tip test, then ultrasound and urodynamics study were performed for them Results: nocturia and urgency were significantly more common in those with DI or mixed incontinence than those with GSI. Both Q-tip test and ultrasound were used to assess BNM and so can detect stress incontinence with sensitivity (81.8% versus 36.4%), specificity (50% versus 50%), positive predictive value (81.8% versus 66.7%), negative predictive value (50% versus 22.2%), and accuracy (73.3% versus 40%). From 30 women who underwent urodynamics study, 60% had GSI and 40% had detrusor instability or mixed incontinence. Conclusions: Q-tip test is a useful clinical test and more accurate than ultrasound in detecting bladder neck mobility. Urodynamics study is expensive and time consuming so limit its use to those with urinary incontinence, urgency and nocturia as they are more likely to have detrusor instability or mixed incontinence.