The diagnosis of female stress incontinence--the value of the clinical examination, anamnesis and urodynamics]

A prospective study was performed between November 1989 and August 1990 to evaluate 57 consecutive female patients with urinary incontinence. The aim of the study was to determine whether the indication for surgery could be based solely on an anamnestic evaluation and clinical examination or was corrected by an additional urodynamic test. The anamnestic evaluation alone correctly identified all patients with the diagnosis of stress incontinence in our group of selected patients referred by other urologists. The additional clinical examination confirmed this diagnosis in all patients and additionally led to diagnosis of a vesicovaginal fistula in one patient. The urodynamic testing confirmed the clinical and anamnestic diagnosis in all patients and identified urge incontinence as the leading symptom in one patient with an unclear diagnosis. Our results show that urodynamic studies are important to establish a precise indication for surgery but are not necessary in every patient. A possible alternative to routine urodynamic testing in female urinary incontinence is its application only when there is an obvious discrepancy between the carefully evaluated history of incontinence and the findings of the clinical examination.