Editing AUA: Female SUI (2023) (section)

=== History and Physical Exam ===

==== History ====
* '''<span style="color:#ff0000">Characterize incontinence</span>''' (stress, urgency, mixed, continuous, without sensory awareness).
** Presence of coughing, sneezing, lifting, walking, or running as initiators of incontinence increases the likelihood of SUI as the cause of urinary leakage
** '''<span style="color:#ff0000">Chronicity of symptoms</span>'''
** '''<span style="color:#ff0000">Frequency, bother, and severity</span>''' of incontinence episodes. Pad or protection use.
*** '''<span style="color:#ff0000">An assessment of bother is paramount to the decision to operate in the index patient.</span>'''
* '''<span style="color:#ff0000">Associated</span>''' 
**'''<span style="color:#ff0000">Urinary tract symptoms</span>''' (e.g., urgency, frequency, nocturia, dysuria, hematuria, slow flow, hesitancy, incomplete emptying)
** '''<span style="color:#ff0000">Pelvic symptoms</span>''' (e.g., pelvic pain, pressure, bulging, dyspareunia)
**'''<span style="color:#ff0000">GI symptoms</span>''' (e.g., constipation, diarrhea, splinting to defecate)
* '''<span style="color:#ff0000">Menopausal status</span>'''
* '''<span style="color:#ff0000">Obstetric history</span>''' (e.g., gravity, parity, method of delivery)
* '''<span style="color:#ff0000">Previous pelvic surgeries</span>'''
* '''<span style="color:#ff0000">Past medical history</span>''' (e.g., hypertension, diabetes, history of pelvic radiation)
* '''<span style="color:#ff0000">Current and past medications</span>'''
* '''<span style="color:#ff0000">Fluid, alcohol, and caffeine intake</span>'''
* '''<span style="color:#ff0000">Previous treatments for incontinence</span>''' (e.g., behavioral therapy, Kegel exercises/pelvic floor muscle training, pharmacotherapy, surgery)
* '''<span style="color:#ff0000">Patient’s expectations of treatment</span>''' (patient-centered goals)
* '''<span style="color:#ff0000">History alone, while helpful, does not definitively diagnose SUI in women</span>'''

==== Physical exam (6): ====
# '''<span style="color:#ff0000">Stress test (supine and/or standing) with comfortably full bladder</span>'''
# '''<span style="color:#ff0000">Focused abdominal examination</span>'''
# '''<span style="color:#ff0000">Urethral mobility</span>''' (Q-tip test or other method)
# '''<span style="color:#ff0000">Pelvic prolapse</span>''' (any method)
# '''<span style="color:#ff0000">Vaginal atrophy/estrogenization status</span>'''
# '''<span style="color:#ff0000">Focused neurologic examination</span>'''

==== Objective demonstration of SUI ====
* '''<span style="color:#ff0000">Stress test (supine and/or standing) with comfortably full bladder</span>'''
** Considered positive if involuntary urine loss from the urethral meatus is witnessed coincident with increased abdominal pressure
*** A positive stress test had a high sensitivity and specificity for detecting SUI
** '''If leakage is not witnessed in the supine position, the test may be repeated in the standing position to facilitate the diagnosis'''

==== Urinalysis ====
* Screen for abnormalities (microscopic hematuria, pyuria, etc.), which may prompt further investigations and reveal underlying cause (bladder tumour, for example) of incontinence

==== Post-void Residual (PVR) ====
* May prompt further investigations and reveal underlying cause (overflow, for example) of incontinence