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.

Stamey-Martius procedure for severe genuine stress incontinence.

There are few options now available to treat patients with severe genuine stress incontinence caused by urethral failure. These patients usually have a low maximum urethral closure pressure (less than 20 cm of water) and anterior vaginal wall scarring caused by previous surgery. In 32 such patients we used the Martius fat pad insertion procedure, in addition to the Stamey procedure, and achieved a 91% symptomatic success rate over a mean 13-month follow-up period.

Urodynamic investigation in the management of incontinent women.

One hundred and sixty-eight women presenting to a Urinary Incontinence Clinic were studied. Only 52% had a urodynamic diagnosis that supported their clinical signs and symptoms. The response rates to various modalities of treatment for each urinary disorder are described.

Treatment of the unstable bladder with propantheline and imipramine.

This study shows propantheline and imipramine to be effective in the management of the unstable bladder. It emphasizes the need for urodynamic studies for the accurate diagnosis of urinary incontinence. Comparisons have been made of the efficacy of propantheline and imipramine in various groups of incontinent women and indicates that in appropriately selected groups the 'cure' rate is over 70% but if sphincter weakness is excluded, urodynamics cannot differentiate between those women with unstable bladders who will respond to this medication and those who will not.