The sign of stress incontinence--should we believe what we see?

The accuracy of the clinical sign of stress incontinence in the diagnosis of genuine stress incontinence (GSI) was evaluated in 863 (consecutive) women, 779 of whom were referred with the symptom of urinary incontinence. Subjects were assessed clinically and urodynamically by the one clinician (PLD). The positive and negative predictive values of the clinical sign of stress incontinence for a diagnosis of GSI were 91% and 50% respectively. Of the 569 women with GSI, 335 (59%) had GSI as their sole diagnosis and 234 (41%) had an additional urodynamic diagnosis. The clinical sign of stress incontinence when present was a reliable guide to a final diagnosis of GSI. Clinical assessment of incontinent women requires the back-up of urodynamic studies in order to make an accurate diagnosis.