Proper diagnosis: a must before surgery for stress incontinence.

Stress urinary incontinence is just one of many possible reasons for incontinence in a female patient. It is important to determine the exact etiology of the urinary incontinence because successful treatment depends on an accurate diagnosis. Many additional factors such as age, level of activity, presence and degree of pelvic prolapse, detrusor abnormalities, and coexisting medical conditions must be considered during the incontinence evaluation. The physical examination should assess urethral mobility and genital prolapse abnormalities. Bladder storage abnormalities such as poor compliance are accurately assessed using current urodynamic methods, but detrusor control abnormalities, such as detrusor instability, are not. The urodynamic evaluation is directed toward identifying and quantifying urinary leakage attributable to excursions of abdominal pressure utilizing abdominal (Valsalva) leak-point pressure testing. A focused evaluation allows the appropriate operative procedure to be selected, yielding optimal long-term results.