Original article
Diagnostic classification of female urinary incontinence: An epidemiological survey corrected for validity

https://doi.org/10.1016/0895-4356(94)00147-IGet rights and content

Abstract

Diagnostic questions about stress and urge incontinence were validated against a final diagnosis made by a gynecologist after urodynamic evaluation. Thereafter, an epidemiological survey was performed, using similar questions, and correcting the answers for lack of validity. Included were 250 incontinent women at the out-patient clinic and 535 women who reported incontinence in the epidemiological survey. The sensitivity for stress incontinence was 0.66 (95% confidence interval ± 0.08), specificity 0.88 (± 0.06). The corresponding values for urge incontinence were 0.56 (± 0.15) and 0.96 (± 0.03), and for mixed incontinence 0.84 (± 0.10) and 0.66 (± 0.07). Using these indices of validity as corrective measures for the diagnostic distribution reported in the epidemiological survey, the percentage of stress incontinence increased from 51 to 77%, while mixed incontinence was reduced from 39 to 11%. Pure urge incontinence increased from 10 to 12%. Mixed incontinence will be overreported in epidemiological surveys. Correction for validity indicates that a larger majority than hitherto reported may have pure stress incontinence.

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    Scores range from 0 to 35 with 8–35 indicating the presence of LUTS (8–19 moderate, 20–25 severe) (Barry et al., 1992). Urinary incontinence in women was determined based on incontinence frequency and amount of urine lost per episode (drops, small splashes, more), using the validated Sandvik Severity Index (Sandvik et al., 1995). The Sandvik Severity Index is calculated from frequency and amount of urine loss on a scale of 0 to 12 (dry/mild – 0 to 2, moderate – 3 to 6, severe – 8 to 9, very severe – 12) with scores 3 to 12 indicating moderate/very severe UI.

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