Table 4.

Pretreatment Evaluation Procedures and Purposes

History taking

Note onset of problem, impact on QOL, and degree of bother Identify symptoms Track development of symptoms Rule out chronic illnesses that affect fluid balance (eg, CHF, DM, renal insufficiency) Rule out medications with urinary adverse effects (eg, diuretics, antidepressants, antipsychotics, anticholinergics, sympathomimetics, OTC agents) Determine parity Assess prior pelvic surgeries

Physical examination

Assess vaginal prolapse Assess vaginal turgor Evaluation for occult neurologic condition Objective demonstration of SUI on cough stress test

Urinalysis

Evaluate for hematuria, pyuria, etc

PVR*

Rule out overflow incontinence

Cystoscopy*

Visualize urethral and bladder lumen for signs of anatomic abnormalities, irritation, etc

Urodynamic studies*

Confirm SUI Assess urethral function (VLPP) Assess for occult urge urinary incontinence Evaluate compliance

^*Optional (physician’s choice).

QOL, quality of life; CHF, congestive heart failure; DM, diabetes mellitus; OTC, over-the-counter; PVR, post-void residual urine volume; SUI, stress urinary incontinence; VLPP, Valsalva leak point pressure.