Abstract
Objective
To determine whether evaluation of the first occurring symptom and bother of mixed
urinary incontinence (MUI) might help in the clinical assessment of incontinent women.
Study design
Prospective observational study carried out in a tertiary referral urogynaecology
unit in London. Women who underwent urodynamic investigations for MUI were asked whether
stress or urgency incontinence was the first occurring symptom and which was the most
bothersome one. Sensitivity, specificity, positive predictive value (PPV) and negative
predictive value (NPV) for the first occurring symptom and most bothersome component
of their mixed urinary incontinence symptoms in relation to the urodynamic diagnosis
were calculated.
Results
One hundred and eighty women with MUI were studied. Initial or most bothersome urgency
urinary incontinence (UUI) had a good specificity and PPV for diagnosing detrusor
overactivity (DO). When UUI was the initial and most bothersome symptom the specificity
and NPV increased up to 93% and 73%. Stress urinary incontinence (SUI) as first occurring
or most bothersome had a moderate specificity, PPV and NPV for diagnosing urodynamic
stress incontinence (USI). When SUI was the initial and most bothersome symptom the
specificity, PPV and NPV increased up to 91%, 70% and 78%. Initial or most bothersome
UUI with antecedent or most bothersome SUI had a high specificity and good NPV for
a mixed urodynamic diagnosis of DO and USI.
Conclusions
Determination of the first occurring and most bothersome symptom in women with MUI
relates closely to the urodynamic diagnosis. Therefore, our symptom-guided approach
may in some cases provide useful information directing the clinician towards a more
appropriate therapy when urodynamics are inconclusive or cannot be performed.
Keywords
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Article info
Publication history
Published online: October 16, 2013
Accepted:
September 28,
2013
Received in revised form:
October 3,
2012
Received:
August 11,
2012
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
