Stress incontinence in women. A practical method of evaluation

Stress incontinence in women may have many etiologies, of which the two primary ones are detrusor overactivity (urge incontinence), which is treated medically, and anatomic (pure) stress incontinence, which is treated surgically. At the Ben Taub Gynecologic Urology Clinic, Baylor College of Medicine, 307 women were studied. Evaluations included history and physical examination, Q-tip test, catheterization for culture and residual volume, and CO2 gas urethroscopy with single-channel cystometrics. Twenty-nine percent of the patients were found to have pure anatomic stress incontinence, 33% to have urge incontinence and 38% to have combined urge and anatomic stress incontinence; 57% had irritative symptoms regardless of the etiologies. Cystocele was present in 92% of stress, 49% of urge and 83% of combined cases. Patients with anatomic stress incontinence tended to have larger cystoceles and greater Q-tip angles; however, a significant percentage of patients with urge incontinence also had cystoceles and abnormal Q-tip angles. Treatment must therefore be individualized on the basis of anatomic and physiologic findings. Of the patients, 40% were treated surgically, and 69% received some form of medical treatment, including antispasmodics, estrogen, Kegel's exercises, urethral dilatation and bladder drills; 9% were given a trial of medical therapy followed by surgical therapy. This practical approach to evaluating women with stress incontinence is easily used in the practitioner's office.