Urinary Incontinence: Diagnostic Tests

Obligatory medical device diagnostics.

  • Sonography (ultrasonography) or urosonography (assessment of the morphology of the urogenital tract/urinary and reproductive tract).
    • Residual urine determination – determination of the amount of urine remaining in the urinary bladder after urination Note: With anticholinergic medication, residual urine determination should be performed before and during anticholinergic medication.
    • Determination of bladder capacity when the bladder is full.
    • Bubble wall thickness
    • Female pelvic floor (= pelvic floor sonography; urogynecologic ultrasound): Urethra (urethra), bladder, symphysis and vagina (vagina), uterus (uterine) and Douglas space (pocket-shaped bulge of the peritoneum (peritoneum) between rectum (rectum) behind and uterus in front), rectum, anal sphincter and the pelvic floor muscles – for morphological diagnosis of incontinence and pelvic floor dysfunction[Descensus of urethra/urethra and bladder; Cystocele/protrusion of the urinary bladder into the anterior vaginal wall; rectocele/expulsion of the anterior wall of the rectum into the vagina and enterocele (“intestinal hernia”); diverticulum (“protrusion”) of the urethra or vaginal cysts/vaginal cysts]
    • Male pelvic floor: urethra (urethra), meatus urethrae internus (internal urethral orifice), base of bladder, symphysis; for visualization, the ultrasound probe is held on the perineum (perineum, i.e., region between anus and external genital organs) with only a slight contact pressure

    Note: In urinary incontinence including micturition problems (discomfort during urination), the following changes / diseases are possible: prostate enlargement, bladder stones, intra- or paravesical space, sludge and bladder wall thickening and urinary bladder diverticula (sac-like protrusion of the bladder wall).

Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.

  • Optional tests:
    • Stress test (cough stress test) – This test can objectify involuntary urine leakage. If urine leakage occurs when the bladder is full during laughter, sneezing or coughing, or physical exercise such as squatting, this is an indication of stress incontinence (formerly stress incontinence; loss of urine during physical exertion as a result of a bladder closure problem). The sensitivity (percentage of diseased patients in whom the disease is detected by using the procedure, i.e., a positive finding occurs) for stress incontinence was 67% in the sitting position and 79% in the standing position, according to one study. The specificity (probability that actually healthy people who do not have the disease in question are also detected as healthy in the test) was 90% in standing and 100% in sitting.
    • Diaper test (PAD test or pad-weight test//diaper weight test; template weight test) – weight measurement of a diaper/template after a defined load.
  • Uro-sonography – ultrasound examination of the urinary tract (kidney, bladder, urethra), especially by perineal sonography or introitus sonography (placing the transducer on the perineum or in the vaginal entrance (introitus). These ultrasound examinations provide information about the configuration of the bladder neck at rest and under stress and have largely replaced the diagnosis by X-ray imaging (urethrocystography) (use as preoperative diagnostics).
  • Urogram (excretory urogram) – e.g., detection of renal scarring in chronic urinary tract infections or structural abnormalities.
  • Urodynamic diagnostics (including measurement of bladder function during filling via a catheter and subsequent emptying (pressure-flow analysis) to differentiate the various forms of urinary incontinence (stress, urge incontinence also mixed forms, neurogenic bladder).
  • Uroflowmetry (urine flow measurement) – measurement of urine flow during bladder emptying to objectively determine bladder emptying disorders.
  • Cystometry (urinary bladder pressure measurement) – qualitative and quantitative information is obtained about the function of the bladder muscles.
  • Urethra pressure profile (urethral pressure profile) – measurement of urethral closure pressure.
  • Urethrocystography (lateral (lateral) urethrocystography or lateral cystogram) – imaging of the urethra and urinary bladder with by X-rays.Largely replaced by ultrasound: see uro-sonography.
  • Micturition cystourethrography (MZU, MCU) – radiographic imaging of the urethra and urinary bladder during micturition (urination). Largely superseded by ultrasound: see urosonography.
  • Urethrocystoscopy (urethral and bladder endoscopy) – confirms non-invasive findings in the urinary bladder. These may include: Bladder stones, bladder tumors, bladder diverticula, endovesically developed prostate adenomas (prostate enlargement) and carcinomas (prostate cancer), vesicointestinal or vesicovaginal fistula formations.
  • Rectoscopy (rectoscopy of the rectum).
  • Dynamic functional MRI (magnetic resonance imaging; dMRI):