Abstract
The aim of this study was to evaluate the role of urodynamic test in diagnosis of urinary incontinence, comparing detailed data of history and physical examination, and some easy- to-apply clinical tests. A cross-sectional retrospective study was carried out by reviewing the medical charts of 55 patients with complaint of loss of urine, seen at the Urogynecology Service of Women's Health Outpatient Clinic of Hospital Universitário de Jundiaí, between October 2006 and March 2007. The patients answered a specific questionnaire involving the epidemiological and physical examination variables considered in this study. They were submitted to physical examination and urodynamic tests. The complaint of loss of urine upon exertion, either isolated or associated with urge incontinence, was confirmed by urodynamic tests in most women, and only 4 of 49 symptomatic women had negative results. The clinical sign was present in 35 patients (63.6%), and 46 patients (83.6%) had the exertion component in the urodynamic test. The exertion component was observed in 10 (18%) out of 15 patients without symptoms (30%). The positive and negative predictive values of the clinical sign for diagnosis of any type of urinary incontinence in this studied group were 97.1 and 26.7%, respectively. As for the clinical complaint of urinary loss upon exertion, the positive and negative predictive values for any type of urinary incontinence were 92 and 40%, respectively. For the clinical complaint of urge incontinence, the positive and negative predictive values of 92.5 and 23.1%, respectively. It was concluded that the urodynamic evaluation is an important instrument to evaluate the severity of incontinence, although it was not necessary to diagnose loss of urine. The finding of urinary loss during physical examination had low sensitivity and specificity in diagnosis of the type of loss of urine. Urodynamic tests had better performance in demonstrating urinary incontinence in patients with complaint of incontinence upon exertion and without loss of urine seen upon physical examination than in confirming urge incontinence in patients with those symptoms.
Highlights
Urinary incontinence (UI) is defined as any clinically proven involuntary loss of urine which causes a social or hygienic problem[1]
The data from the physical examination were considered after inspecting the external genitalia to characterize and classify the degree of genital dystopia, as follows: a)prolapse of the anterior vaginal wall, which was classified as absent; first degree, when it does not reach the vaginal introitus during stress; second degree, when it reaches the vaginal introitus during stress; third degree, when it trespasses the vaginal introitus upon stress and fourth degree, when it trespasses the vaginal vestibule upon rest; b)prolapse of the posterior vaginal wall, classified as grade 1, when it does not affect the vaginal introitus upon stress; degree 2, when it reaches the vaginal introitus upon stress and degree 3, when it trespasses the vaginal introitus upon stress
Who participated in the study had not been through any prior consultation for such reason. These findings coincide with other reports in the literature, in which 21.3 to 27% of women visited physicians on account of their UI . [5,23,24] Considering the impact on quality of life that such problem can cause, most women in the present study considered loss of urine as a severe problem or felt very upset because of it, differently from the results reported by Hannestad et al, in which most women with incontinence reported it as a mild problem[18]
Summary
Urinary incontinence (UI) is defined as any clinically proven involuntary loss of urine which causes a social or hygienic problem[1]. This symptom has social implications, causing discomfort and loss of self-esteem, negatively impacting the quality of life of many women. It is a change that affects approximately one third of women of all ages It is very likely an undernotified disorder and one of the reasons for this is that many UI patients do not spontaneously report this problem, unless when probed by physicians[2]. The most frequent cause of UI is stress urinary incontinence (SUI)(3), which is translated as a symptom, a sign and a condition. The second most common cause of UI among women stems from hyperactivity of the detrusor muscle (hyperactive bladder)
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