Aims: Pad per day (PPD) usage is a frequently utilized measure of urinary incontinence. The 24-hour pad weight test (24PWT) is a reproducible test for quantifying incontinence volumes. We investigated whether PPD validly reports the magnitude of urinary incontinence. Methods: This was a retrospective review of patients undergoing stress incontinence surgery from July 2002 to 2005. Inclusion criteria were a documented 24PWT and patient-reported PPD usage. Grams of urine loss per pad (GPP) provided a third measure of incontinence. Descriptive statistics and correlations between all variables and signi¢cance were noted. Factor analysis was performed on the three measures of leakage and age for all patients over age 50. Results: One hundred forty-¢ve male and 116 female patients met inclusion criteria. Correlated against 24PWT, GPP has the strongest association with a correlation of 0.80 for males and 0.88 for females. PPD has a weaker correlation of 0.64 for males and 0.61 for females (R 2 ¼ 0.38 overall). Factor analysis identi¢ed two components associated with incontinence. A ''leakage'' component correlated best with 24PWT and GPP. Additionally, an ''age'' component implies that despite stable 24PWT values, older patients increase GPP while PPD decreases. Conclusions: Self-reported PPD is an unreliable measure of incontinence as this variable only measures 38% of the variation of urinary incontinence volume. Patients at a given PPD level present with a wide range of 24PWT values. Older patients have higher per-pad leakage. Future incontinence studies should report 24PWT to ensure the most reliable and uniform data.

Aims: The purpose of this study was to determine whether a percutaneous needle electrode (PNE) technique or a surgical ¢rst stage lead placement (FSLP) better predicted whether a patient would progress to implantation of a pulse generator (IPG) in older urge incontinent women. Methods: Thirty subjects 55 years with refractory urge incontinence who had been selected to undergo a test stimulation procedure were randomized to either PNE or FSLP. Thirteen underwent PNE placement and seventeen underwent FSLP placement. If during the test stimulation period subjects had greater than 50% improvement in their incontinence parameters they quali¢ed for permanent lead and/or IPG implantation of the Interstim 1 device. Results: Twenty-one subjects (70%) responded to the test stimulation and underwent implantation, 15/17 (88%) in the FSLP group and 6/ 13 (46%) in the PNE group. Subjects who were randomized to the FSLP group were signi¢cantly more likely to proceed to implantation of the IPG (P ¼ 0.02) than those in the PNE group. There was no signi¢cant di¡erence in demographics, pre-test stimulation incontinence parameters or poststimulation visual analog pain scores between the randomized groups or between test stimulation responders and non-responders. When comparing FSLP and PNE responders, there was no signi¢-cant di¡erence in the percent improvement in 24-hr pad weight, daily pad usage, or daily incontinence. Conclusion: FSLP better predicted progression to implantation of the IPG than a test stimulation with a PNE in an older urge incontinent cohort. Neurourol. Urodynam. 26: 14^18, 2007. ß 2006

Due to its significant citraturic effect, lemonade therapy appears to be a reasonable alternative for patients with hypocitraturia who cannot tolerate first line therapy. Future study in the form of a prospective, randomized trial is needed to validate these findings.

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