Diagnostic Algorithms in Female Urinary Incontinence

Summary

Urinary incontinence is frequent problem with significantly negative impact on the quality of life. The correct plan of examination leads to the proposal of the appropriate treatment. The history, correct judgment of symptoms of incontinence and detailed gynaecological examination are important at the beginning of the diagnostic process. Negative urine cultivation is necessary condition for the invasive investigation of the urinary tract. Special questionnaires, micturition diary and clinical tests belong to the physical examination. The pad-weight test is based on the measurement of weight gain of absorbent pads during a test period under standardised conditions. Q-tip test (cotton swab test) measures the degree of mobility of urethra and bladder neck. Most of the clinical tests can be replaced by the ultrasound examination (introital or perineal approach), which helps to appreciate the vigour of urethra, bladder neck and vagina during the resting period and at stress. Urodynamic examination records pressure changes during the bladder filling, pressure gradients in urethra and the velocity of the urinary flow. It should be carried out when antiincontinence surgery is planned or when conservative therapy failed. Urodynamic examination helps to distinguish between stress and urge type of incontinence. Urethrocystoscopy is indicated for the diagnosis of the recurrent urinary infections, urge incontinence when structural pathologies of the urinary bladder are suspected, iatrogenic incontinence or postoperative complications. 

Key words:
female urinary incontinence, diagnostics, ultrasonography, urodynamics, urethrocystoscopy.