Symptom-based, clinical, and urodynamic diagnoses of urinary incontinence: how well do they correlate in postmenopausal women?

Objective: : The objective of this study was to determine the correlation between symptom-based, clinical, and urodynamic (UD) diagnoses of urinary incontinence in postmenopausal women.

Methods: : This is a review of results of UD findings in postmenopausal women with signs and/or symptoms of urinary incontinence. Positive predictive values (PPVs) were calculated for symptom-based and clinically assigned diagnoses by subtype of incontinence and UD diagnosis.

Results: : A total of 105 postmenopausal women with signs and/or symptoms of urinary incontinence underwent UD testing. Subjects were predominantly white (95.1%), with average age 61 (SD, ±9). Overall, symptom diagnosis matched UD diagnosis 27% of the time. Similarly, clinical diagnosis matched UD diagnosis 27% of the time. All 3 diagnoses (symptom, clinical, and UD) matched 18% of the time. Report of urine loss with Valsalva had a PPV of 0.57, for UD diagnosis of stress incontinence. For symptoms of urge and mixed incontinence, PPVs were 0.22 and 0.11, respectively. Clinical diagnoses of stress, urge, and mixed incontinence as compared with UD diagnosis showed PPVs of 0.64, 0.30, and 0.09, respectively. PPV for any UD diagnosis of incontinence was 0.69 by symptoms and 0.71 by clinical evaluation.

Conclusions: : The correlation between type of urinary incontinence based on symptoms, clinical evaluation, and UD findings is poor overall in postmenopausal women. It is highest with stress and lowest with mixed incontinence. The voiding diary and cough stress test are valuable tools in predicting type of incontinence by UD testing.