title: Standing cough test for evaluation of post-prostatectomy incontinence: a pilot study.
abstract: BACKGROUND
  We implemented a standardized Standing Cough Test (SCT) for assessment of men with post-prostatectomy incontinence (PPI) and stratified results according to an objective clinical grading scale in an attempt to facilitate male anti-incontinence surgical procedure selection.
  
  
  METHODS
  SCT was routinely performed during the initial outpatient consultation for PPI. Incontinence severity was recorded based on a novel Male Stress Incontinence Grading Scale (MSIGS) to stratify PPI. Each patient was assigned an incontinence grade score of 0 through 4 during the SCT. Men with mild stress urinary incontinence (SUI) (grades 0-2) were offered sling surgery while those with heavier SUI (grades 3-4) were offered artificial urinary sphincter (AUS). MSIGS grade was correlated to preoperative patient-reported pads per day (PPD), and patient-reported outcomes of anti-incontinence surgery were assessed.
  
  
  RESULTS
  Among 62 consecutive PPI patients, 20 (32%) were graded as mild based on SCT, while the majority (42/62, 68%) were graded as moderate-severe. Average time from prostatectomy to treatment was 6 years. MSIGS grade demonstrated a strong correlation with preoperative PPD (r = 0.74). Among the 53 patients who underwent surgery for PPI, 14 with mild SUI received a sling, while 39 (74%) more severe cases received an AUS. Patient-reported improvement was high overall in both groups (median 95%).
  
  
  CONCLUSIONS
  Most men with chronic PPI present for definitive treatment in a delayed manner after prostatectomy despite having severe incontinence. The SCT provides immediate, objective information about the severity of PPI which strongly correlates with patient-reported pads-per-day and may expedite anti-incontinence surgical procedure selection.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
authors.forename: Nirmish
authors.initials: N
authors.lastname: Singla
authors.forename: Maude
authors.initials: M
authors.lastname: Carmel
authors.forename: Alexandra
authors.initials: A
authors.lastname: Klein
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Tausch
authors.forename: Jordan
authors.initials: J
authors.lastname: Siegel
authors.forename: Isamu
authors.initials: I
authors.lastname: Tachibana
authors.forename: Jeremy
authors.initials: J
authors.lastname: Scott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003371:Cough; D006801:Humans; D016496:Incontinence Pads; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011468:Prostatectomy / Q000009:adverse effects*; D012720:Severity of Illness Index; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial