Role of Clinical History and Physical Examination in the Diagnosis of Urinary Incontinence - Revista Brasileira de Ginecologia e Obstetrícia
Purpose: to analyze the prevalence of urogynecological symptoms and their relationship with final urodynamic diagnosis, and to compare the clinical sign of stress urinary incontinence with urodynamic diagnosis. Methods: a total of 114 patients were included in a retrospective study from June 2000 to January 2001. All patients were evaluated through medical interview, physical examination and urodynamic study. They were classified according to clinical symptom, presence of clinical sign of urine loss and urodynamic study. The data analysis was performed using a test to determine sensitivity, specificity, and positive and negative predictive values. Results: the mean age was 51 years (19-80), 61 patients (53.5%) were in menacme and 53 (46.5%) in postmenopausal stage. Ten (18.8%) were using hormone replacement therapy and 25 (21.9%) had been submitted to surgery for incontinence. The isolated clinical symptom of urine loss was reported in 41 (36.0%) patients, the isolated urgency/urgency-incontinence in 13 (11.4%) and mixed symptoms in 60 (52.6%). In the urodynamic study, of all patients with symptom of isolated urine loss, 34 (83%) had stress urinary incontinence (SUI), no patient had detrusor instability (DI), 2 (4.9%) had mixed incontinence (MI) and 5 (12.1%) had a normal result. Of all patients with isolated urgency/urgency-incontinence, in the urodynamic study, none had SUI, 5 (38.5%) had ID, 1 (7.7%) had MI and 7 (53.8%) had a normal result. Of the patients with mixed symptoms, we identified, on the urodynamic evaluation, 25 (41.6%) who had SUI, 10 (16.7%) ID, 10 (16.7%) MI and 15 (25.0%) a normal result. The clinical sign of urine loss was identified in 50 (43.9%) patients. A total of 35 (70%) had SUI on urodynamic study, 6 (12%) had SUI and another diagnosis and 9 (18%) did not have SUI. Urine loss was absent in 64 (56.1%) women. Of those 23 (35.9%) had SUI on urodynamic study, 7 (11%) had SUI and another diagnosis and 34 (53.1%) did not have SUI. Conclusions: clinical history and physical examination are important in the management of urinary incontinence, although they should not be used as the only diagnostic method. Objective tests are available and should be used together with clinical data.
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Purpose: to analyze the prevalence of urogynecological symptoms and their relationship with final urodynamic diagnosis, and to compare the clinical sign of stress urinary incontinence with urodynamic diagnosis. Methods: a total of 114 patients were included in a retrospective study from June 2000 to January 2001. All patients were evaluated through medical interview, physical examination and urodynamic study. They were classified according to clinical symptom, presence of clinical sign of urine loss and urodynamic study. The data analysis was performed using a test to determine sensitivity, specificity, and positive and negative predictive values. Results: the mean age was 51 years (19-80), 61 patients (53.5%) were in menacme and 53 (46.5%) in postmenopausal stage. Ten (18.8%) were using hormone replacement therapy and 25 (21.9%) had been submitted to surgery for incontinence. The isolated clinical symptom of urine loss was reported in 41 (36.0%) patients, the isolated urgency/urgency-incontinence in 13 (11.4%) and mixed symptoms in 60 (52.6%). In the urodynamic study, of all patients with symptom of isolated urine loss, 34 (83%) had stress urinary incontinence (SUI), no patient had detrusor instability (DI), 2 (4.9%) had mixed incontinence (MI) and 5 (12.1%) had a normal result. Of all patients with isolated urgency/urgency-incontinence, in the urodynamic study, none had SUI, 5 (38.5%) had ID, 1 (7.7%) had MI and 7 (53.8%) had a normal result. Of the patients with mixed symptoms, we identified, on the urodynamic evaluation, 25 (41.6%) who had SUI, 10 (16.7%) ID, 10 (16.7%) MI and 15 (25.0%) a normal result. The clinical sign of urine loss was identified in 50 (43.9%) patients. A total of 35 (70%) had SUI on urodynamic study, 6 (12%) had SUI and another diagnosis and 9 (18%) did not have SUI. Urine loss was absent in 64 (56.1%) women. Of those 23 (35.9%) had SUI on urodynamic study, 7 (11%) had SUI and another diagnosis and 34 (53.1%) did not have SUI. Conclusions: clinical history and physical examination are important in the management of urinary incontinence, although they should not be used as the only diagnostic method. Objective tests are available and should be used together with clinical data.
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