Simplifying the management of stress incontinence

Controversy exists as to how many of the newer diagnostic procedures should be used to evaluate stress incontinence. Urethral closure pressure, uroflowmetry, barium paste, and chain cystograms may be unphysiologic and studies that are not required preoperatively for every patient. Two hundred fifty-three cases in this study were evaluated by history, stress test, and urinalysis alone, if no urgency component was present. The patients with urgency and stress incontinence were studied by routine cystoscopy. These patients all had stress incontinence that was socially unacceptable. The stress test was very simple and done without foreign bodies in the urethra, without sudden bladder distention, and without irritation of bladder mucosa. The patient simply came into the office with a full bladder and a desire to void, and the stress test was done with the patient in the standing position, with one doctor and one nurse in attendance. The results of treatment with this workup are presented with follow-up.