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The standard 1-hour pad test: does it have any value in clinical practice?
M Abdel-fattah1, J W Barrington, M Youssef
1Department of Obstetrics and Gynaecology, Royal Alexandra Hospital, Paisley, PA2 9PN, UK. msakr99@aol.com
Objectives:
The aim of this study was to determine whether self subjective assessment of urinary incontinence as perceived by female patients could replace the standard 1-hour pad test in clinical practice.
Design:
Prospective cohort study.
Setting:
District General Hospital, South West of England.
Methods:
Ninety women awaiting surgical treatment for urodynamic stress incontinence were recruited. They underwent 160 pad tests; on each test women were asked to classify themselves on a four point scale into one category (0: totally continent to urine, 1: mild/occasional urinary incontinence (UI), 2: moderate UI, 3: severe UI), to complete the King's Health Questionnaire (KHQ) and carry out the standard International Continence Society 1-hour pad test. A pad gain >1 gm was considered a positive result.
Main Outcome Measures:
Women perception for severity of UI, 1-hour pad gain, KHQ scores.
Results:
Self subjective assessment of UI (continent vs. incontinent) had good correlation (r = 0.88) with the pad test result (negative vs. positive), and correlated well with the KHQ scores (r = 0.79). Poor correlation was seen between the pad gain and the KHQ scores (r = 0.48) and between the pad gain and the self subjective assessment of UI scale (r = 0.48). The self subjective assessment of UI (incontinent vs. continent) had sensitivity 95.65% and specificity 93.33% to detect the pad test results (positive vs. negative).
Conclusion:
This study suggest that, in either the pre- or postoperative phase, simply asking a woman if she is continent for urine or not was as good as doing the pad test and correlated better with the patient quality of life.