title: The association between post-void leakage and coital incontinence and intrinsic sphincter deficiency among women with urinary incontinence.
abstract: OBJECTIVE
  : To identify whether an association exists between post-void urinary leakage and/or coital incontinence and the diagnosis of intrinsic sphincter deficiency (ISD) among women with urinary incontinence.
  
  
  METHODS
  : Ninety women presenting to a tertiary urogynecology office with complaints of urinary incontinence were included in this retrospective chart review. All patients underwent a complete history and physical examination, including direct questioning about the symptoms of post-void leakage and coital incontinence. Multichannel urodynamic testing was evaluated for each patient and ISD was defined by a Valsalva leak point pressure of less than or equal to 60 cm H2O and/or a maximal urethral closure pressure of less than or equal to 20 cm H2O. The prevalence of ISD among those patients with post-void leakage and/or coital incontinence was evaluated.
  
  
  RESULTS
  : The prevalence of ISD among the study population was 64%. Intrinsic sphincter deficiency was diagnosed in 45/62 patients with post-void leakage and in 13/28 patients without post-void leakage (72.6% and 46.4%, respectively, P = 0.0311). Intrinsic sphincter deficiency was present in 21/24 patients with coital incontinence and 37/66 patients without coital incontinence (87.5% and 56.1%, respectively, P = 0.0061). Patients with both symptoms were diagnosed with ISD 90% of the time, while only 41.7% of patients with neither symptom had ISD (P = 0.0014, sensitivity = 64.5%). Patients with either symptom were diagnosed with ISD 72.7% of the time, compared to 41.7% of patients with neither symptom (P = 0.0117, sensitivity = 82.8%). The positive predictive value for coital incontinence alone and ISD was 87.5%, and for both symptoms was 90%.
  
  
  CONCLUSIONS
  : The symptoms of post-void leakage and coital incontinence are associated with ISD. The strong positive predictive value of both symptoms with ISD should encourage physicians to include direct questioning about these symptoms during the history taking and treatment planning for women with urinary incontinence.
authors.affiliation: From the *Department of Obstetrics and Gynecology, Buffalo Clinic, Buffalo, MN; and †Division of Urogynecology and Reconstructive Pelvic Surgery, Riverside Methodist Hospital, Columbus, OH.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Emery
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Book
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Novi