Urinary incontinence assessment

The urinary incontinence assessment is a urodynamic exploration specifically directed at the aetiological diagnosis and characterisation of urinary leakage. It aims to determine the mechanism of the incontinence (stress, urgency, mixed) and to quantify its severity in order to guide the treatment strategy. Stress urinary incontinence is due to a failure of the urethral closure mechanisms during rises in abdominal pressure. The assessment then includes urethral profilometry to measure the closure pressure, and a stress leak test (Valsalva test or cough test with a full bladder) to reproduce and quantify the leakage. Urgency incontinence (or overactive bladder incontinence) is caused by involuntary contractions of the detrusor. Filling cystometry can reveal these uninhibited contractions, measure their amplitude and correlate them with the symptoms reported by the patient. The detection of detrusor overactivity profoundly changes the therapeutic approach. Mixed incontinence, combining a stress component and an urgency component, is common and requires a complete assessment to rank the two components. Treatment of the predominant component will be given priority as first-line management. The incontinence assessment also includes a pad test (pad weighing test) to objectively quantify the leakage over a given period.