Reliability of urodynamic interpretation in women presenting with urinary incontinence at a tertiary hospital

Urodynamic testing is often regarded as essential to the proper diagnosis of bladder storage and emptying disorders but urodynamic testing is an invasive and expensive procedure. Pakistan is a developing country with limited provision of urogynecological services, and therefore few urodynamic studies.

This cross-sectional study was conducted from January 2009 to January 2010 at the Aga Khan University Hospital to assess the frequency of agreement between clinical findings and urodynamic studies in accurately diagnosing urinary incontinence.

We included 157 women and their symptoms of urge urinary incontinence (UUI), stress urinary incontinence (SUI) or mixed urinary incontinence were matched with urodynamic study findings.

Out of 157 women 47 (29.9%) presented with SUI and 33 (21%) with UUI but urodynamic stress incontinence (USI) was found in 59 (37.6%) and detrusor overactivity in 38 (24.2%). This shows a reliability level of ĸ = 0.41 for SUI and ĸ = 0.7 for UUI. There was a weak agreement (ĸ = 0.33) between clinical findings of urinary incontinence and urodynamic studies; in 78 cases (49.7%) the urodynamic findings matched the clinical findings.

The poor level of agreement between clinical findings and urodynamic study interpretations re-emphasizes the fact that the bladder is not a reliable source of identifying urinary symptoms in women.