office evaluation of urinary incontinence

Procedure

• stress maneuvers - confirm stress incontinence
  • have patient cough while standing with a full bladder
  • observe for leakage of urine
• normal voiding
  • small volumes or difficulty voiding suggests obstruction or impaired bladder contractility
• postvoid residual
  • insert a 14-French straight catheter within 10 minutes of a normal void
  • measure residual volume
    • a residual volume of > 100 mL implies outlet obstruction or impaired contractility
• bladder filling (after postvoid residual)
  • procedure
    • attach a 50 mL catheter-tip syringe to catheter
    • hold syringe 15 cm above bladder
    • fill with 25-50 mL aliquots of sterile water at room temperature until patient feels a strong urge to void, then remove catheter
  • observe
    • 1st urge to void
    • occurrence of involuntary contractions (upward water movement
    • bladder capacity
• repeat stress maneuvers