A comparison of the cough stress test and single-channel cystometry with multichannel urodynamic evaluation in genuine stress incontinence.

OBJECTIVE: To assess the predictability and accuracy of a simplified approach--the cough stress test and single-channel cystometry--in the diagnosis of genuine stress incontinence (GSI) by comparing these tests to the more complex multichannel cough urethral pressure profile and urethrocystometry. Conversely, we assessed the predictability and accuracy of the multichannel approach--the cough urethral pressure profile and urethrocystometry--in GSI by comparing these tests to the cough stress test and single-channel cystometry.
METHODS: Prospectively, 145 women with complaints of urinary incontinence underwent a complete urogynecologic evaluation. All patients underwent single-channel cystometry with cough stress test and multichannel urethrocystometry with cough urethral pressure profiles in the erect position. Genuine stress incontinence was diagnosed if 1) the patient was seen to spurt urine per urethra with cough at full cystometric capacity in the absence of vesical instability as determined by single-channel cystometry, or 2) the cough urethral pressure profile demonstrated pressure equalization in the absence of vesical instability as determined by multichannel urethrocystometry. Statistical values were calculated for both the simplified and the multichannel methods, and measures of validity were compared statistically.
RESULTS: For the diagnosis of GSI, the simplified method had a positive predictive rate of 87.2% and a negative predictive rate of 80.6%. The multichannel method had a positive predictive rate of 84.0% and a negative predictive rate of 84.4%.
CONCLUSION: For the diagnosis of GSI, the simplified method of the cough stress test and single-channel cystometry is as accurate and predictive as the multichannel method.