Factors associated with the presence of genuine stress incontinence in females

Forth-five premenopausal women were enrolled in the study. All patients underwent a complete diagnostic evaluation, which included the completion of a standardized questionnarie, a detailed history, a complete physical examination and multichannel urodynamic testing. Clinical findings and urodynamic parameters were recorded. Logistic regression analysis and ² comparisons were used to determine which factor(s) were most associated with the presence of genuine stress incontinence. Thirty patients had genuine stress incontinence, and 15 asymptomatic volunteers without subjective and objective lower urinary tract dysfunction served as controls. A significant difference in age, maximum urethral closure pressure, strength of cough and bladder-neck mobility was found between the two groups. Logistic regression analysis revealed that bladder-neck mobility was the variable most associated with the presence of genuine stress urinary incontinence. This study supports the concept the genuine stress incontinence is probably multifactorial, and its etiology remains unknown.Editorial Comment: This is one of the few studies that has attempted to correlate possible etiologic factors for genuine stress incontinence in both symptomatic subjects as well as asymptomatic controls. The factor found to be most associated with stress incontinence was the mobility of the urethrovesical junction, as measured by the angle of the Q-tip from the horizontal, when compared to the controls. We should not be misled by this, however, since hypermobility is so common that many patients have this anatomical abnormality without ever having stress incontinence. The diagnosis of stress incontinence cannot therefore be made by the simple presence of urethral hypermobility. The authors correctly conclude that the etiologic factors in stress incontinence are multifactorial, and the collage of information presented by the patient in both clinical and urodynamic terms must be considered in the determination of the ultimate diagnosis.