The cough stress test (CST) is a common and accepted tool to evaluate stress urinary incontinence but there is no agreement on how the test should be conducted. We assessed the diagnostic ability of different CSTs performed varying patient's position and bladder volumes using urodynamic stress urinary incontinence (USI) as the gold standard. The 24-hour pad test was also evaluated.
Women presenting to specialty outpatient clinics with complaints of urinary incontinence and recommended to undergo urodynamic testing were recruited. 140 patients were randomized to four CST groups including: (A)comfortably full bladder, (B)empty bladder, (C)bladder infused with 200cc of saline, and (D)bladder filled to half-functional capacity. The sequence of standing and sitting was randomly assigned. Group comparisons were performed using one-way ANOVA or generalized Fisher exact test. The Kappa statistic was used to evaluate the agreement between the sitting and standing positions. Confidence intervals for sensitivity and specificity were calculated using the Wilson method. ROC analysis was used to evaluate the performance of the 24-hour pad test.
The CST performed with a bladder filled to half-functional capacity was the best performing test (sensitivity 83%, specificity 90%). There was no statistically significant evidence that the sensitivity or specificity of one CST differed from the others. The pad test had no significant predictive ability on the diagnosis of USI (AUC 0.60, p=0.08).
CSTs are accurate for diagnosing USI. The 24-hour pad test was not predictive of USI and not helpful when used in conjunction with the CST.
The Journal of urology. 2017 Nov 23 [Epub ahead of print]
Joseph W Henderson, Sarah M Kane, Jeffrey M Mangel, Elias G Kikano, Jorge A Garibay, Robert R Pollard, Sangeeta T Mahajan, Sara M Debanne, Adonis K Hijaz
University Hospitals Cleveland Medical Center, Department of Urology, Division of Female Pelvic Medicine and Reconstructive Surgery, 11000 Euclid Avenue, Cleveland, OH 44106, USA. Electronic address: ., Norton Healthcare, 4123 Dutchmans Lane, Suite 307, Louisville, KY 40207, USA., MetroHealth Medical Center, Department of Obstetrics and Gynecology, 2500 Metrohealth Dr., Cleveland, OH 44109, USA., University Hospitals Cleveland Medical Center, Department of Urology, Division of Female Pelvic Medicine and Reconstructive Surgery, 11000 Euclid Avenue, Cleveland, OH 44106, USA., Department of Population and Quantitative Health Sciences, School of Medicine, WG51, Case Western Reserve University, Cleveland, OH 44106, USA.