The value of bladder filling in the clinical detection of urine loss and selection of patients for urodynamic testing.

Bladder filling was used to enhance the clinical detection of urine loss in 37 women who attended a general gynaecological outpatient clinic with lower urinary tract symptoms and incontinence. Videocystourethrography was performed subsequently in all women, and the clinical and fluoroscopic detection of urine loss compared. The two methods of detecting urine loss agreed in all but four women with very slight genuine stress urinary incontinence, two being detected by one but not by the other of the two tests. In only 5 of 25 patients was incontinence demonstrable clinically without bladder filling, and in only 13 of 25 was it demonstrable in the supine position. These proportions were 5 of 21 and 10 of 21, respectively, for those with genuine stress incontinence, with or without coexistent detrusor instability. Bladder filling provoked uncontrollable voiding in five women, two had detrusor instability on cystometry, and two had low peak urinary flow rates on uroflowmetry. The significance of these findings is discussed in the context of selecting patients for urodynamic testing.