Significance of pad test loss for the evaluation of women with urinary incontinence

The aim of this study was to determine whether the objective incontinence severity, as measured by the pad test, correlated with urethral parameters, and if the objective incontinence severity was differentiated by the incontinence types and also, if it influenced the patient's clinical outcome.

Two hundred seventy-four female patients who had undergone a tension-free vaginal tape procedure between March 1999 and May 2003 were retrospectively reviewed. The 1 hr pad test was carried out as recommended by the International Continence Society, with some modification. The mean patient age was 55.1 years (range: 28-80). Two hundred-one women (73.3%) that complained of stress urinary incontinence and another 73 women (26.7%) that had additional symptoms of urge incontinence were enrolled as study subjects. A cure for incontinence, after the tension-free vaginal tape procedure, was defined as the absence of a subjective complaint of leakage and the absence of objective leakage on stress testing, and all other cases were considered failures.

In linear regression analysis, the Valsalva leak point pressure (VLPP) was the only explanatory variable influencing the objective incontinence severity. The urine leakage was significant higher in the mixed urinary incontinence group than in the stress urinary incontinence group (39.7 +/- 7.5 g vs. 30.3 +/- 2.8 g, P < 0.05). For the total patients, the failure group had a more severe preoperative objective severity than the cure group (53.2 +/- 16.6 vs. 32.0 +/- 3.0, P < 0.05). Upon a subgroup analysis, a similar result was found in the stress urinary incontinence group (87.1 +/- 8.2 vs. 29.8 +/- 2.8, P < 0.05) but not in the mixed urinary incontinence group.

Our findings suggest that the amount of urine leakage as measured during the pad test may be associated with the clinical outcome, after the anti-incontinence surgery.