Tests
1st tests to order
cough stress test
Test
Performed during routine evaluation of the incontinent patient.[1] The bladder is filled with 300 mL of sterile fluid and the patient performs a Valsalva maneuver while in dorsal lithotomy position. If leakage is observed, the test is positive. If not, the patient performs the test in the standing position. If leakage is noted, the test is positive.
Result
urine leakage
urinalysis
Test
Urinary tract infection may cause urinary urgency, frequency, and/or urgency incontinence.[60] If results are suspicious for urinary tract infection, may send urine culture to confirm.
Hematuria or infection may indicate an underlying malignancy. Further evaluation to determine etiology may be warranted.
Result
normal or may show WBCs, nitrites, red blood cells with underlying infection or malignancy
post-void residual measurement
Test
This is done after a spontaneous void.
May confirm urinary retention.
Determined by ultrasound or sterile catheterization.
A post-void residual measurement (PVR) ≥100 mL may be considered as indicating urinary retention. However, there is no established definition for elevated PVR. May be indicative of voiding dysfunction or outlet obstruction.
Result
elevated if ≥100 mL or ≥50% voided volume
empty supine stress test
Test
The patient should perform a Valsalva maneuver while in the dorsal lithotomy position immediately after spontaneously voiding. If leakage is observed from urethral meatus, the test is positive.
Result
urine leakage
Tests to consider
urodynamic testing
Test
Can help to differentiate types of incontinence if unclear, especially if results of less invasive tests are inconclusive.[1] Helpful in complicated cases (failed anti-incontinence surgery, history of pelvic surgery, advanced pelvic organ prolapse, neurogenic bladder, or pelvic radiation).[67]
The bladder is filled with sterile fluid. Changes such as first sensation, desire to void, and bladder capacity are recorded electronically during the filling and storage phase. Urinary loss from the urethra during provocative maneuvers, such as coughing, is documented.
Urodynamic testing is not needed prior to surgery for uncomplicated stress incontinence or overactive bladder if office tests such as cough stress test or empty supine stress tests are positive.[7][62][63][68][69][70]
Result
urinary dysfunction (leakage or detrusor overactivity, or urinary retention) is reproduced during testing
pad test
Test
Can be performed when urinary incontinence is unclear or to confirm a urinary source.
Can be done after 1 hour of activity with a full bladder, or during a 24- to 48-hour period.
If results are unclear, oral phenazopyridine can be given to differentiate between urine loss and vaginal secretions: pyridium pad test.
Result
positive pad weight if >1 g in 1 hour or >4 g in 24 hours
Q-tip test
Test
Test can be performed at the time of urodynamic testing or follow-up pelvic examination to clarify disease type. A lubricated Q-tip is placed into the urethra up to the bladder neck. A Valsalva effort while in dorsal lithotomy position causes deflection in Q-tip angle from baseline (horizontal axis). Results may impact surgical management.
Urethral hypermobility (>30 degrees) may lead the physician to perform a corrective surgical procedure (i.e., sling), whereas lack thereof may lead the physician to address a sphincteric abnormality with an alternate procedure, such as periurethral bulking. However, applicability of this test varies significantly between practitioners.[7]
Result
change in degree ≥30 degrees
ultrasound
Test
Urethral mobility is an associated factor in stress incontinence. Transperineal ultrasound can identify structural and functional abnormalities of the bladder neck and urethra. Abnormal (hypermobile) bladder neck descent is used as a marker of urethral mobility.[71]
Do not perform diagnostic renal and bladder ultrasound in the initial workup of an uncomplicated patient with symptoms of overactive bladder.[62][63][69]
Result
bladder neck descent ≥25 cm
cystourethroscopy
Test
Can aid in diagnosis of patients with hematuria or a history of pelvic surgery, or in those patients who have failed traditional treatments.
Test can be performed in the office. A zero-degree cystoscope is first used to visualize the urethra. A 70-degree cystoscope is then placed in the bladder to evaluate for normal anatomy or presence of pathology including a vesicovaginal or urethrovaginal fistula, a foreign body, a tumor/mass, or interstitial cystitis. Do not perform cystoscopy in the initial workup of an uncomplicated patient with symptoms of overactive bladder.[7][69]
Result
may reveal fistula, foreign body, tumor, or interstitial cystitis
Use of this content is subject to our disclaimer