The pad test is clearly underutilized. Well-designed studies providing level one evidence are lacking. Numerous variations in how the test is performed by individual urologists make the evaluation of published literature difficult. Future research goals should include randomized studies leading to establishment of optimal protocols of testing for clinical research and daily care.

The teaching module "Pad Weight Testing in the Evaluation of Urinary Incontinence" was prepared by a Working Group of the ICS (International Continence Society) Urodynamics Committee. The module includes a PowerPoint presentation describing testing requirements, clinical workup, and analysis and is available at http://www.icsoffice.org/ eLearning. The associated article evaluates pad testing, summarizes current evidence, and provides recommendations. Where evidence is unavailable or no consensus exists, expert opinion is given.The pad test provides a noninvasive diagnostic option for urinary incontinence (UI) that is easy to perform and inexpensive. When results are correlated with patient questionnaires or other diagnostic information, and the test is used appropriately, it has clear value in initial diagnosis, selection of treatment, and follow-up evaluation. Surveys have reported that that less than10% of urologists use the pad test routinely in their practice. Various testing durations and protocols have been reported, but only the 1-hour pad test has a standardized protocol. One-hour pad tests provide qualitative information and are useful during initial workup to select treatment and estimate prognosis for cure. Twenty-four-hour and longer testing quantifies the degree of urine leakage.One-hour pad tests: Patients perform a set of specified "physical activities before testing. These include the following: standing up from a sitting position, vigorous coughing, running on the spot, bending to pick up an object from the floor, and washing hands in running water. The specified activities can be modified for patients with physical limitations. Because results are affected by a number of factors, too much weight should not be given to a negative 1-hour test. Repeated 1-hour pad tests are recommended especially when the test result does not correlate with subjective assessment provided by patient questionnaires.Twenty-four pad tests: The quantitative information provided by a 24-hour test gives an estimate of the amount of urine leakage and is useful for evaluation of treatment outcomes; this and longer pad tests are used in clinical studies. Results of testing depend on patient compliance, fluid intake, physical activity levels, hormonal status, and sexual activity, as well as environmental factors (temperature, humidity). Outcome is also influenced by the type of pad used, leakage, and evaporation. Therefore, pads should be exchanged every 4 to 6 hours during the 24-hour and longer pad tests. Unlike 1-hour testing, only normal activities are performed (which are recorded in a voiding diary).Summary: Pad testing is a simple, easy-to-use, and inexpensive testing method that provides useful information when it is used appropriately, and results are correlated with other diagnostic methods. Only the protocol for the 1-hour pad test has been standardized. A standard protocol for 24-hour-or-longer pad testing does not exist at present and should be established with randomized studies. EDITORIAL COMMENT(This article p...