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A Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence.

Authors
  • Henderson, Joseph W1
  • Kane, Sarah M2
  • Mangel, Jeffrey M3
  • Kikano, Elias G4
  • Garibay, Jorge A3
  • Pollard, Robert R3
  • Mahajan, Sangeeta T4
  • Debanne, Sara M5
  • Hijaz, Adonis K4
  • 1 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, Ohio. Electronic address: [email protected]
  • 2 Norton Healthcare, Louisville, Kentucky.
  • 3 Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio.
  • 4 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
  • 5 Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
Type
Published Article
Journal
The Journal of urology
Publication Date
Jun 01, 2018
Volume
199
Issue
6
Pages
1557–1564
Identifiers
DOI: 10.1016/j.juro.2017.11.073
PMID: 29175541
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The cough stress test is a common and accepted tool to evaluate stress urinary incontinence but there is no agreement on how the test should be performed. We assessed the diagnostic ability of different cough stress tests performed when varying patient position and bladder volume using urodynamic stress urinary incontinence as the gold standard. The 24-hour pad test was also evaluated. We recruited women who presented to specialty outpatient clinics with the complaint of urinary incontinence and who were recommended to undergo urodynamic testing. A total of 140 patients were randomized to 4 cough stress test groups, including group 1-a comfortably full bladder, group 2-an empty bladder, group 3- a bladder infused with 200 cc saline and group 4-a bladder filled to half functional capacity. The sequence of standing and sitting was randomly assigned. The groups were compared by 1-way ANOVA or the generalized Fisher exact test. The κ statistic was used to evaluate agreement between the sitting and standing positions. The 95% CIs of sensitivity and specificity were calculated using the Wilson method. ROC analysis was done to evaluate the performance of the 24-hour pad test. The cough stress test performed with a bladder filled to half functional capacity was the best performing test with 83% sensitivity and 90% specificity. There was no statistically significant evidence that the sensitivity or specificity of 1 cough stress test differed from that of the others. The pad test had no significant predictive ability to diagnose urodynamic stress urinary incontinence (AUC 0.60, p = 0.08). Cough stress tests were accurate to diagnose urodynamic stress urinary incontinence. The 24-hour pad test was not predictive of urodynamic stress urinary incontinence and not helpful when used in conjunction with the cough stress test. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

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