Abstract
The aim of this study is to determine if the diagnostic accuracy of the supine empty stress test (SEST) differs depending on the volume of residual urine. We performed a review of all patients who were diagnosed with stress urinary incontinence (SUI) via multi-channel urodynamics including valsalva leak point determinations (VLPP). A SEST was performed and the residual urine recorded via catheterization. The test-specific indices of the SEST for the prediction of low VLPP (defined as <60 cm H20) were determined for varying residual volumes. Ninety-nine patients were included. Regardless of residual volume, low sensitivities, specificities and positive predictive values were demonstrated. Sensitivity and positive predictive values were further reduced and negative predictive values were improved slightly with higher residual volume. The highest negative predictive value was 89% at a residual volume of greater than 10 mL. Residual urine volume has minimal impact on the utility of the SEST.
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The opinions and conclusions in this article are those of the authors and are not intended to represent the official position of the Department of Defense, United States Air Force, or any other government agency.
Editorial Comment: The authors attempt to answer a clinically relevant question regarding the diagnostic accuracy of supine empty cough test at different residual volumes. They conclude that urinary residual volume has no impact on the utility of this screening test. The study design was not optimal to come to the above conclusion. However, they reaffirm the high negative predictive value of supine empty stress test found in some previous studies. This study further establishes the usefulness of this test as a simple office screening test for intrinsic sphincter deficiency. This test should be incorporated as part of a routine office evaluation of stress urinary incontinence in general gynecology clinics and could be used as a criterion for further testing or a referral.
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Walter, A.J., Thornton, J.A. & Steele, A.C. Further characterization of the supine empty stress test for predicting low valsalva leak point pressures. Int Urogynecol J 15, 298–301 (2004). https://doi.org/10.1007/s00192-004-1172-6
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DOI: https://doi.org/10.1007/s00192-004-1172-6