4- Demonstration of Stress Incontinence: Cough Stress Test
Stress urinary incontinence should be objectively demonstrated before any anti-incontinence surgery is performed (10–12). Visualization of fluid loss from the urethra simultaneous with a cough is diagnostic of SUI. Delayed fluid loss is considered a negative cough stress test result and suggests cough-induced detrusor overactivity. The cough stress test can be performed with the patient in the supine position during the physical examination. However, if urine leakage is not observed, the cough stress test needs to be repeated with the patient standing and with a full bladder (or a minimum bladder volume of 300 mL) to maximize test sensitivity. Health care providers often ask patients to come to the office with a full bladder during an initial evaluation so that the cough stress test can be performed before bladder emptying (12).To perform the cough stress test in the standing position, the patient stands near the examination table with one foot on the table step. The health care provider then bends and separates the labia to visualize the urethral meatus. The patient is then asked to cough while the health care provider directly visualizes the urethra. If no leakage is observed despite patient symptoms of SUI, the health care provider needs to ensure that the patient had a full bladder by measurement of voided urine volume and postvoid residual urine volume by catheterization or bladder ultrasonography. The health care provider may need to retrograde fill the bladder until the patient feels bladder fullness or is holding at least 300 mL of fluid and then repeat the cough stress test. If the standing cough stress test result remains negative despite patient symptoms of SUI, then multichannel urodynamic testing is recommended.