title: Does the onset or bother of mixed urinary incontinence symptoms help in the urodynamic diagnosis?
abstract: OBJECTIVE
  To determine whether evaluation of the first occurring symptom and bother of mixed urinary incontinence (MUI) might help in the clinical assessment of incontinent women.
  
  
  METHODS
  Prospective observational study carried out in a tertiary referral urogynaecology unit in London. Women who underwent urodynamic investigations for MUI were asked whether stress or urgency incontinence was the first occurring symptom and which was the most bothersome one. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the first occurring symptom and most bothersome component of their mixed urinary incontinence symptoms in relation to the urodynamic diagnosis were calculated.
  
  
  RESULTS
  One hundred and eighty women with MUI were studied. Initial or most bothersome urgency urinary incontinence (UUI) had a good specificity and PPV for diagnosing detrusor overactivity (DO). When UUI was the initial and most bothersome symptom the specificity and NPV increased up to 93% and 73%. Stress urinary incontinence (SUI) as first occurring or most bothersome had a moderate specificity, PPV and NPV for diagnosing urodynamic stress incontinence (USI). When SUI was the initial and most bothersome symptom the specificity, PPV and NPV increased up to 91%, 70% and 78%. Initial or most bothersome UUI with antecedent or most bothersome SUI had a high specificity and good NPV for a mixed urodynamic diagnosis of DO and USI.
  
  
  CONCLUSIONS
  Determination of the first occurring and most bothersome symptom in women with MUI relates closely to the urodynamic diagnosis. Therefore, our symptom-guided approach may in some cases provide useful information directing the clinician towards a more appropriate therapy when urodynamics are inconclusive or cannot be performed.
authors.affiliation: Department of Urogynaecology, St. Mary's Hospital, Imperial College NHS Trust, London, United Kingdom. Electronic address: a.digesu@imperial.ac.uk.
authors.forename: G Alessandro
authors.initials: GA
authors.lastname: Digesu
authors.forename: Alexandros
authors.initials: A
authors.lastname: Derpapas
authors.forename: Sarah
authors.initials: S
authors.lastname: Hewett
authors.forename: Andrea
authors.initials: A
authors.lastname: Tubaro
authors.forename: Federica
authors.initials: F
authors.lastname: Puccini
authors.forename: Ruwan
authors.initials: R
authors.lastname: Fernando
authors.forename: Vik
authors.initials: V
authors.lastname: Khullar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D053201:Urinary Bladder, Overactive / Q000175:diagnosis; D014550:Urinary Incontinence, Stress / Q000175:diagnosis*; D053202:Urinary Incontinence, Urge / Q000175:diagnosis*; D014563:Urodynamics
keywords: Bothersome; Mixed urinary incontinence; Onset; Urodynamics