The standard 1-hour pad test: does it have any value in clinical practice?

OBJECTIVES

The aim of this study was to determine whether self subjective assessment of urinary incontinence as perceived by female patients could replace the standard 1-hour pad test in clinical practice.

DESIGN

Prospective cohort study.

SETTING

District General Hospital, South West of England.

METHODS

Ninety women awaiting surgical treatment for urodynamic stress incontinence were recruited. They underwent 160 pad tests; on each test women were asked to classify themselves on a four point scale into one category (0: totally continent to urine, 1: mild/occasional urinary incontinence (UI), 2: moderate UI, 3: severe UI), to complete the King's Health Questionnaire (KHQ) and carry out the standard International Continence Society 1-hour pad test. A pad gain >1 gm was considered a positive result.

MAIN OUTCOME MEASURES

Women perception for severity of UI, 1-hour pad gain, KHQ scores.

RESULTS

Self subjective assessment of UI (continent vs. incontinent) had good correlation (r = 0.88) with the pad test result (negative vs. positive), and correlated well with the KHQ scores (r = 0.79). Poor correlation was seen between the pad gain and the KHQ scores (r = 0.48) and between the pad gain and the self subjective assessment of UI scale (r = 0.48). The self subjective assessment of UI (incontinent vs. continent) had sensitivity 95.65% and specificity 93.33% to detect the pad test results (positive vs. negative).

CONCLUSION

This study suggest that, in either the pre- or postoperative phase, simply asking a woman if she is continent for urine or not was as good as doing the pad test and correlated better with the patient quality of life.