"The cough game": are there characteristic urethrovesical movement patterns associated with stress incontinence?
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.
Division of Gynecology, Pelvic Floor Research Group, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA. clewicky@med.umich.edu
Christina
C
Lewicky-Gaupp
Jerry
J
Blaivas
Amanda
A
Clark
Edward J
EJ
McGuire
Gabriel
G
Schaer
Julie
J
Tumbarello
Ralf
R
Tunn
John O L
JO
DeLancey
D000328:Adult; D016022:Case-Control Studies; D003371:Cough / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D018608:Ultrasonography, Doppler; D014521:Urethra / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000503:physiopathology*