Question 21

A 38 yo female presents with urinary incontinence. During the exam, she leaks urine with laughing. Her pelvis exam is normal except a swab test showing a 40-degree change. Urinalysis is normal. No significant medical or surgical history. What is the minimal diagnostic evaluation needed before going to surgery?

Answer Choices:

Bladder diary

Cystoscopy

Postvoid residual

Urodynamics

No additional steps required

Correct Answer:

Postvoid residual

Explanation:

  • Evaluation of a patient with urinary incontinence should include an objective demonstration of urinary incontinence and a postvoid residual

  • ACOG recommends using a swab test to assess urethral mobility (hypermobility is defined as greater than 30 degrees)

  • Cystoscopy can be performed for concerning symptoms like hematuria, recurrent infections

  • Urodynamics do not offer added benefit in uncomplicated patients with incontinence. They can be used to diagnose intrinsic sphincter deficiency which is better treated by retropubic sling, but this patient does not have risk factors (smoking, hypoestrogen, prior urologic surgery)