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International Urogynecology Journal
Published in: International Urogynecology Journal 12/2012

01-12-2012 | Editorial

The urethra is a reliable witness: simplifying the diagnosis of stress urinary incontinence

Author: Charles W. Nager

Published in: International Urogynecology Journal | Issue 12/2012

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Excerpt

In 1970, Bates, Whiteside, and Turner-Warwick [1] wrote that: “…the bladder often proves to be an unreliable witness…” and this phrase has been used for more than 40 years as a justification for urodynamic studies (UDS) in the evaluation of urinary incontinence. However, two studies published this year in the New England Journal of Medicine have reported the predictive value of direct observation of fluid loss from the urethra in making the diagnosis of stress urinary incontinence (SUI) [2] and occult SUI [3]. The studies suggest that for SUI or occult SUI, appropriate management decisions can be made with an office evaluation that includes demonstrating urine loss from the urethra without additional UDS. …
Literature
1.
Bates CP, Whiteside CG, Turner-Warwick R (1970) Synchronous cine-pressure-flow-cysto-urethrography with special reference to stress and urge incontinence. Br J Urol 42(6):714–723PubMedCrossRef
2.
Nager CW, Brubaker L, Litman HJ, Zyczynski HM, Varner RE, Amundsen C et al (2012) A randomized trial of urodynamic testing before stress-incontinence surgery. N Engl J Med 366(21):1987–1997PubMedCrossRef
3.
Wei JT, Nygaard I, Richter HE, Nager CW, Barber MD, Kenton K et al (2012) A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med 366(25):2358–2367PubMedCrossRef
4.
Nager C (2011) The value of the preoperative prolapse reduction stress test in women without stress incontinence symptoms undergoing vaginal prolapse surgery with or without a TVT: results from the OPUS trial. Female Pelvic Med Reconstr Surg 17(5 Suppl 2):S53
5.
Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17PubMedCrossRef
Metadata
Title
The urethra is a reliable witness: simplifying the diagnosis of stress urinary incontinence
Author
Charles W. Nager
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
International Urogynecology Journal / Issue 12/2012
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-012-1892-y

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