Introduction
The goals of the basic evaluation are to confirm urinary incontinence (UI) and to identify factors that may be contributing to or resulting from UI. The general evaluation of UI should include a history, fluid intake/voiding diary, physical examination, urinalysis, urine culture, and measurement of postvoid residual urine. For selected patients, a blood test (urea and creatinine), urodynamic evaluation, cystoscopy, and imaging studies of the urinary tract or the central nervous system may be recommended.
History
A patient’s history should include the problem’s onset, duration, progression, evolution, and precipitating factors (Valsalva maneuvers, change of position). A clear understanding of the severity of the problem and its impact on quality of life should be sought. A patient’s expectations from treatment should also be noted for it is often essential to make these conform to realistic results. Important associated urinary symptoms such as pain, burning, frequency, urgency, hesitancy, postvoid dribbling, nocturia, nocturnal enuresis, hematuria, constipation, fecal incontinence, sexual dysfunction, dyspareunia, and prolapse symptoms should also be recorded.
Structured condition-specific questionnaires may be used and may be administered either by the clinician or self-administered. Questionnaires may facilitate disclosure of embarrassing symptoms, ensure that symptoms are not omitted, and standardize information, thereby aiding in follow-up of intervention and research.
A through review of the patient’s medical history is recommended to ascertain any conditions that possibly interfere with urinary output, such as renal insufficiency, diabetes mellitus, congestive heart failure, pelvic radiation therapy for treatment of cancer, or neurological diseases such as multiple sclerosis, Parkinson’s disease, or stroke. Chronic constipation, for example, has been associated with voiding difficulties, urgency, stress incontinence, and increased bladder capacity. For certain patients, an assessment of mobility and living environment is also important.
All medications taken by the patient, including antihypertensive drugs, diuretics, sedatives, hypnotics, analgesics, and antidepressants must be documented. Intake of caffeine should be determined because it is also associated with overactive bladder symptoms. Finally, strong coughing associated with chronic pulmonary disease can markedly worsen the symptoms of stress urinary incontinence (SUI).
A review of the patient’s obstetric history is also important. This includes parity, types of delivery, perineal repairs, and difficult deliveries.
Last, the surgical history should include all genitourinary surgical interventions for treatment of incontinence or pelvic prolapse.
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Adonis Hijaz, MD and Firouz Daneshgari, MD
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REFERENCES
- Abrams P, Cardozo L, Khoury S, Wein A, eds. Incontinence. Second International Consultation on Incontinence, 2nd ed., Plymbridge Distributors, Plymouth, UK, 2002.
- Agency for Health Care Policy and Research. Urinary Incontinence Clinical Practice Guidelines, US Department of Health and Human Services, Agency for Health Care Policy and Research, Washington, DC, 1996.
- Weidner AC, Myers ER, Visco AG, Cundiff GW, Bump RC. Which women with stress incontinence require urodynamic evaluation? Am J Obstet Gynecol 2001;184:20-26.
- Weber AM, Taylor RJ, Wei JT, Lemack G, Piedmonte MR, Walters MD. The cost-effectiveness of preoperative testing (basic office assessment vs urodynamics) for stress urinary incontinence in women. BJU Int 2002;89:356-363.
