office evaluation of urinary incontinence

Procedure: 1) stress maneuvers - confirm stress incontinence a) have patient cough while standing with a full bladder b) observe for leakage of urine 2) normal voiding - small volumes or difficulty voiding suggests obstruction or impaired bladder contractility 3) postvoid residual a) insert a 14-French straight catheter within 10 minutes of a normal void b) measure residual volume - a residual volume of > 100 mL implies outlet obstruction or impaired contractility 4) bladder filling (after postvoid residual) a) procedure 1] attach a 50 mL catheter-tip syringe to catheter 2] hold syringe 15 cm above bladder 3] fill with 25-50 mL aliquots of sterile water at room temperature until patient feels a strong urge to void, then remove catheter b) observe 1] 1st urge to void 2] occurrence of involuntary contractions (upward water movement 3] bladder capacity 5) repeat stress maneuvers

References

Sepulveda GRECC guidelines