investigation

Last edited 05/2019

• urine testing
  • a urine dipstick test should be undertaken in all women presenting with urinary incontinence (UI) to detect the presence of blood, glucose, protein, leucocytes and nitrites in the urine
  • women with symptoms of urinary tract infection (UTI) whose urine tests positive for both leucocytes and nitrites should have a midstream urine specimen sent for culture and analysis of antibiotic sensitivities. An appropriate course of antibiotic treatment should be prescribed pending culture results
  • women with symptoms of UTI whose urine tests negative for either leucocytes or nitrites should have a midstream urine specimen sent for culture and analysis of antibiotic sensitivities. The healthcare professional should consider the prescription of antibiotics pending culture results
  • women who do not have symptoms of UTI, but whose urine tests positive for both leucocytes and nitrites, should not be offered antibiotics without the results of midstream urine culture
  • women who do not have symptoms of UTI and whose urine tests negative for either leucocytes or nitrites are unlikely to have UTI and should not have a urine sample sent for culture
    
    
• assessment of residual urine
  • measurement of post-void residual volume by bladder scan or catheterisation should be performed in women with symptoms suggestive of voiding dysfunction or recurrent UTI. A bladder scan should be used in preference to catheterisation on the grounds of acceptability and lower incidence of adverse events
  • women who are found to have a palpable bladder on bimanual or abdominal examination after voiding should be referred to a specialist
    
    
• bladder diaries
  • Bladder diaries should be used in the initial assessment of women with UI or OAB. Women should be encouraged to complete a minimum of 3 days of the diary covering variations in their usual activities, such as both working and leisure days
    
    
• urodynamic testing
  • do not perform multichannel filling and voiding cystometry before primary surgery if stress urinary incontinence or stress-predominant mixed urinary incontinence is diagnosed based on a detailed clinical history and demonstrated stress urinary incontinence at examination
    
    

  • after undertaking a detailed clinical history and examination, perform multichannel filling and voiding cystometry before surgery for stress urinary incontinence in women who have any of the following:

    • urge-predominant mixed urinary incontinence or urinary incontinence in which the type is unclear
    • symptoms suggestive of voiding dysfunction
    • anterior or apical prolapse
    • a history of previous surgery for stress urinary incontinence
      
      
      
• do not use imaging (MRI, CT, X-ray) for the routine assessment of women with urinary incontinence
  • ultrasound is not recommended other than for the assessment of residual urine volume

• consider investigating the following symptoms in women with pelvic organ prolapse:
  • urinary symptoms that are bothersome and for which surgical intervention is an option
  • symptoms of obstructed defaecation or faecal incontinence
  • pain
  • symptoms that are not explained by examination findings

Reference:

• 1) NICE (April 2019). Urinary incontinence: The management of urinary incontinence in women