Urodynamic evaluation of stress incontinence.

A careful history points the urodynamic examination in the right direction and enables the examiner to ask the correct questions. The individual who does the test is the only reliable interpreter of the results of that study. No urodynamic technique is as sensitive or specific as a blood glucose, or even an electrocardiogram. A history of urgency and urge incontinence suggests uninhibited contractility and is a better index of that condition than a cystometrogram. Leakage occurring shortly after a previous operative procedure for stress incontinence suggests type III stress incontinence. A past history of radiation, prior pelvic surgery, neurologic disease, herniated disc conditions, or prior chemotherapy all require a simple cystometrogram to rule out abnormal bladder compliance. Following a simple history and urodynamic evaluation, a physical examination should be performed, searching for urethra hypermobility and genital prolapse. Abdominal leak-point pressure testing is useful to assign broad categories of incontinence. Relatively high leak-point pressures with hypermobility suggest suspension operations will be effective. Low leak-point pressures with hypermobility often require a sling, and very low leak-point pressures with no hypermobility indicate a suitable candidate for a trial of injection therapy.