A proposed scoring system for the management of female urinary incontinence

The management of urinary incontinence is frequently ineffective. Inappropriate surgical intervention can convert medically treatable incontinence into a more serious and less remediable condition. To allow a more scientific approach to management, we have developed a scoring system for female incontinence based on three primary controlling factors: (1) the direction of the urethra, (2) the urethral vesical angle and (3) the urethral pressure profile. For each factor a score of 1 to 3 was assigned according to the deviation from normal anatomy or function. Scores ranged from 3 to 9. Patients scoring 6 to 9 were treated surgically, by ventral suspension of the bladder neck and urethra. Patients scoring 3 to 5 were treated medically and underwent surgery only if indicated for other pathology. Thirty-three patients were evaluated and treated with this approach, with a one- to two-year follow-up. This system appears to provide an objective method of choosing between surgical and medical therapy for urinary incontinence.