Last updated: 02/17/2009

Candidates for surgical treatment of incontinence must undergo a full clinical, neurological, and radiographic evaluation before there can be direct analysis of the condition to be treated and the desired outcome. Both urethral and bladder functions...

are evaluated and there is an attempt to determine the conditions associated with stress incontinence. In many women, incontinence may be due to vaginal prolapse. Stress incontinence can be identified by observation of urine during pelvic examination or by a sitting or standing stress test where patients are asked to cough or strain and evidence of leakage is obtained. Gynecologists often use a Q-tip test to determine the angle and change in the position of the urethra during straining. Other tests include subtracted cystometry to measure how much the bladder can hold, how much pressure builds up inside the bladder as it stores urine, and how full it is when the patients feels the urge to urinate.

The frequency of stress incontinence as measured by typical symptoms ranges between 33% and 65%. The frequency of stress incontinence is around 12% when measured or defined by cystometric findings. The ability to distinguish SUI as the cause of incontinence, as opposed to ISD, becomes more complicated; but it is a very important factor in the decision to have surgery. A combination of pelvic examination for urethral hypermoblity and leak point pressure as measured by coughing or other abdominal straining has been shown to be very effective in distinguishing ISD, and identifying the patient who needs surgery.