Office based criteria for predicting type II stress incontinence without further evaluation studies - Comment

Purpose: The 1996 Agency for Health Care Policy and Research Clinical Practice Guidelines for Urinary Incontinence suggested that surgery may be performed after basic evaluation without further testing in cases of uncomplicated nonrecurrent type II stress urinary incontinence. However, they failed to recommend explicit office based criteria to identify this condition without further invasive testing. We establish such criteria and test the efficacy. Materials and Methods: Records of 101 women with urinary incontinence who underwent complete evaluation from June 1995 to September 1997 were reviewed. Basic evaluation consisted of medical history, physical/pelvic examination and the validated Medical, Epidemiologic and Social Aspects of Aging Urinary Incontinence Questionnaire, while further testing included cystourethroscopy, urodynamics and lateral stress cystogram. All cases diagnosed as pure type II stress urinary incontinence after basic and further testing were identified, and office based findings were characterized, which included medical history, questionnaire scores, vaginal speculum examination results and post-void residual urine volume. These criteria were applied in a blinded fashion to the initial group of 101 patients and then to a new group of 45 women with incontinence who recently underwent complete evaluation. Results: Specificity and positive predictive value were 100% in both groups for non surgical cases, compared to 81 and 71% in the initial, and 75 and 60% in the new group, respectively, for surgical cases. Conclusions: Our Office based criteria are 100% specific for predicting pure type II stress urinary incontinence in women with no suspension surgery and, thus, have the potential of reducing the need for further invasive testing and consequently the cost of preoperative evaluation.