, Volume 23, Issue 12, pp 1649-1651

The urethra is a reliable witness: simplifying the diagnosis of stress urinary incontinence

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In 1970, Bates, Whiteside, and Turner-Warwick [1] wrote that: “…the bladder often proves to be an unreliable witness…” and this phrase has been used for more than 40 years as a justification for urodynamic studies (UDS) in the evaluation of urinary incontinence. However, two studies published this year in the New England Journal of Medicine have reported the predictive value of direct observation of fluid loss from the urethra in making the diagnosis of stress urinary incontinence (SUI) [2] and occult SUI [3]. The studies suggest that for SUI or occult SUI, appropriate management decisions can be made with an office evaluation that includes demonstrating urine loss from the urethra without additional UDS.

It probably should not surprise us that SUI is not a condition that requires urodynamic testing. SUI is a urethral problem and current bladder investigations do not investigate urethral conditions very well. Valsalva leak point pressures only indirectly measure urethral pressure, and u