International Urogynecology Journal

, Volume 20, Issue 2, pp 171–175

“The cough game”: are there characteristic urethrovesical movement patterns associated with stress incontinence?

  • Christina Lewicky-Gaupp
  • Jerry Blaivas
  • Amanda Clark
  • Edward J. McGuire
  • Gabriel Schaer
  • Julie Tumbarello
  • Ralf Tunn
  • John O. L. DeLancey
Original Article


This study was carried out to determine whether five experts in female stress urinary incontinence (SUI) could discover a pattern of urethrovesical movement characteristic of SUI on dynamic perineal ultrasound. A secondary analysis of data from a case–control study was performed. Ultrasounds from 31 cases (daily SUI) and 42 controls (continent volunteers) of similar age and parity were analyzed. Perineal ultrasound was performed during a single cough. The five experts, blinded to continence status and urodynamics, classified each woman as stress continent or incontinent. Correct responses ranged from 45.7% to 65.8% (mean 57.4 ± 7.6). Sensitivity was 53.0 ± 8.8% and specificity 61.2 ± 12.4%. The positive predictive value was 48.8 ± 8.2% and negative predictive value was 65.0 ± 7.3%. Inter-rater reliability, evaluated by Cohen’s kappa statistic, averaged 0.47 [95% CI 0.40–0.50]. Experts could not identify a pattern of urethrovesical movement characteristic of SUI on ultrasound.


Stress urinary incontinence Ultrasound Urethrovesical movement 



stress urinary incontinence


maximum urethral closure pressure


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Copyright information

© The International Urogynecological Association 2008

Authors and Affiliations

  • Christina Lewicky-Gaupp
    • 1
    • 7
  • Jerry Blaivas
    • 2
  • Amanda Clark
    • 3
  • Edward J. McGuire
    • 4
  • Gabriel Schaer
    • 5
  • Julie Tumbarello
    • 1
  • Ralf Tunn
    • 6
  • John O. L. DeLancey
    • 1
  1. 1.Division of Gynecology, Pelvic Floor Research Group, Department of Obstetrics and GynecologyUniversity of Michigan Medical SchoolAnn ArborUSA
  2. 2.Department of UrologyNew York-Presbyterian/Weill CornellNew YorkUSA
  3. 3.Division of Gynecology, Department of Obstetrics and GynecologyOregon Health Sciences UniversityPortlandUSA
  4. 4.Department of UrologyUniversity of Michigan Medical SchoolAnn ArborUSA
  5. 5.Department of Obstetrics and GynecologyKantonsspital AarauAarauSwitzerland
  6. 6.Department of Urogynecology, German Pelvic Floor CenterSt. Hedwig HospitalsBerlinGermany
  7. 7.Ann ArborUSA

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