The supine stress test: a simple method to detect intrinsic urethral sphincter dysfunction.

Area of Science:

• Urology
• Female Pelvic Medicine
• Diagnostic Testing

Background:

• Stress urinary incontinence (SUI) significantly impacts quality of life.
• Accurate diagnosis of intrinsic urethral sphincter dysfunction (IUS D) is crucial for effective SUI management.
• Current diagnostic methods can be invasive or less accessible.

Purpose of the Study:

• To introduce and evaluate a novel clinical supine stress test.
• To compare the diagnostic accuracy of the supine stress test against abdominal leak point pressure (ALPP) determined by video urodynamics (VUD).
• To assess the reliability of the supine stress test for diagnosing IUS D.

Main Methods:

• Prospective study of patients with SUI undergoing VUD.
• Exclusion of patients with concurrent pelvic organ prolapse or urinary tract infections.
• Performance of a supine stress test with cough and Valsalva maneuvers after bladder filling, with efflux indicating a positive result.
• Diagnosis of IUS D based on ALPP < 100 cm H2O from VUD.

Main Results:

• The supine stress test was positive in 30 of 41 patients.
• Compared to ALPP, the supine stress test demonstrated high diagnostic accuracy: 93.5% sensitivity, 90.0% specificity, 96.7% positive predictive value, and 81.8% negative predictive value for IUS D.
• The test showed excellent correlation with VUD findings.

Conclusions:

• The supine stress test is a simple, rapid, and cost-effective method for diagnosing IUS D.
• A positive supine stress test is a reliable indicator of IUS D.
• The supine stress test serves as a valuable adjunct to other diagnostic tools for SUI management.