Value of the Patient's Case History in Diagnosing Urinary Incontinence in General Practice

Abstract

What is the value of the case history in diagnosing urinary incontinence in general practice? A total of 103 women with urinary incontinence presented to their general practitioner (GP) and underwent a standard history-taking, physical examination and urodynamic testing. The urodynamic diagnoses were analysed against symptoms and symptom complexes. Symptoms of stress incontinence in the absence of symptoms of urge incontinence had a sensitivity of 78%, specificity of 84% and predictive value of 87%. Symptoms of urge incontinence in the absence of symptoms of stress incontinence excluded genuine stress incontinence. Information on age, parity, enuresis, nocturia, frequency, urgency, cystocele, prolapse and hysterectomy did not contribute to a correct diagnosis. It was concluded that urodynamics are unnecessary in most women presenting with urinary incontinence in general practice.

The Sensitivity and Specificity of a Simple Test To Distinguish between Urge and Stress Urinary Incontinence

“…On the basis of previous research (10,11) and expert clinical opinion, we developed a brief, self-administered questionnaire to distinguish urge from stress incontinence that includes 3 questions (the 3 Incontinence Questions [3IQ]) and requires about 30 seconds to complete. To estimate the accuracy of the 3IQ, we conducted a prospective study among ambulatory women with incontinence at 5 academic medical centers in the United States.…”

“It can always happen”: The impact of urinary incontinence on elderly men and women

“…(a) Background characteristics Á age, gender, civil status, level of education, duration of symptoms; Á the type of incontinence: determined on the basis of the following questions [12]: ''does loss of urine occur at moments of increased pressure, for example, when sneezing, jumping or coughing?'' and ''do you experience such a strong urge that you fail to reach the toilet in time?''…”

Systematic review and evaluation of methods of assessing urinary incontinence

“…Nineteen were performed in secondary care, one in primary care 125 and one did not specify where the study was performed. 119 All of these studies used the presence or absence of stress incontinence symptoms as their index test compared with the reference test of multichannel urodynamics, except for one study that used single-channel urodynamics as the reference standard.…”

“…Thirteen studies were performed in secondary care and one in primary care. 125 Eight studies provided a full cross-tabulation of results and the data from these studies were combined to provide a pooled sensitivity of 0.61 (95% CI 0.57 to 0.65) and specificity of 0.87 (95% CI 0.85 to 0.89) for the diagnosis of DO in women by clinical history (Figure 4). Although all of these studies used symptoms of urge incontinence it is probable that different amounts and types of questions were used and different cut-offs applied.…”