The Sensitivity and Specificity of a Simple Test To Distinguish between Urge and Stress Urinary Incontinence

16 May 2006 | Volume 144 Issue 10 | Pages 715-723

Background: Urinary incontinence is common in women. Because treatments differ, urge incontinence should be distinguished from stress incontinence. To make this distinction, current guidelines recommend an extensive evaluation that is too time-consuming for primary care practice.

Objective: To test the accuracy of a simple questionnaire to categorize type of urinary incontinence in women.

Design: Multicenter, prospective study of the accuracy of the 3 Incontinence Questions (3IQ) compared with an extended evaluation to distinguish between urge incontinence and stress incontinence.

Setting: 5 academic medical centers in the United States.

Participants: 301 women enrolled from April to December 2004 who were older than 40 years of age (mean age, 56 years [SD, 11]) with untreated incontinence for an average of 7 years (SD, 7) and a broad range of incontinence severity.

Measurements: All participants included in the analyses answered the 3IQ questionnaire, and a urologist or urogynecologist who was blinded to the responses performed the extended evaluation. Sensitivity, specificity, and likelihood ratios were determined for the 3IQ.

Results: For classification of urge incontinence and with the extended evaluation as the gold standard, the 3IQ had a sensitivity of 0.75 (95% CI, 0.68 to 0.81), a specificity of 0.77 (CI, 0.69 to 0.84), and a positive likelihood ratio of 3.29 (CI, 2.39 to 4.51). For classification of stress incontinence, the sensitivity was 0.86 (CI, 0.79 to 0.90), the specificity was 0.60 (CI, 0.51 to 0.68), and the positive likelihood ratio was 2.13 (CI, 1.71 to 2.66).

Limitations: Participants were enrolled by urologists and urogynecologists at academic medical centers.

Conclusions: The 3IQ questionnaire is a simple, quick, and noninvasive test with acceptable accuracy for classifying urge and stress incontinence and may be appropriate for use in primary care settings. Similar studies are needed in other populations. We also need a clinical trial comparing the outcomes of treatments based on the 3IQ and the extended evaluation.

Editors' Notes Context Clinicians and patients need simple, feasible ways to distinguish urge urinary incontinence from stress urinary incontinence. Contribution In this multicenter study, specialists evaluated and diagnosed incontinence in 301 middle-aged and older women who reported 3 or more episodes per week for at least 3 months. The authors developed a 3-item, self-administered questionnaire to classify women as having urge incontinence or stress incontinence. The answers to the questionnaire increased the likelihood of a final diagnosis of urge incontinence (positive likelihood ratio, 3.29) and stress incontinence (positive likelihood ratio, 2.13). Implications Asking patients some simple and quick questions may help clinicians distinguish urge urinary incontinence from stress urinary incontinence. —The Editors

 

Author and Article Information

From the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; University of Texas Health Science Center at San Antonio, San Antonio, Texas; and Loyola University of Chicago, Maywood, Illinois.

Grant Support: By a UCSF research contract from Astellas Pharma US (formerly Yamanouchi Pharma America).

Potential Financial Conflicts of Interest: Honoraria: C.S. Bradley (Pfizer Inc.), S.R. Kraus (Pfizer Inc., Astellas, Novartis); Grants received: C.S. Bradley (Yamanouchi), S.R. Kraus (National Institutes of Health, Astellas, GlaxoSmithKline).

Requests for Single Reprints: Jeanette S. Brown, MD, University of California, San Francisco, 1635 Divisadero Street, Suite 600, San Francisco, CA 94115; e-mail, brownj{at}obgyn.ucsf.edu.

Read all Rapid Responses

Improving the applicability of a test to distinguish between stress and urge urinary incontinence

Karel G.M. Moons

Annals Online, 19 May 2006 [Full text]

Re: Improving the applicability of a test to distinguish between stress and urge urinary incontinenc

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Annals Online, 22 May 2006 [Full text]

Questinaires are inadequate to prescribe drug therapy for urinary incontinence

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In Response

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Annals Online, 6 Jul 2006 [Full text]