Cough harder during stress urinary incontinence testing, study suggests

DENVER – Patients often do not cough hard enough during the cough stress test for it to identify urinary incontinence, Sudhi Trye, MD, reported at Pelvic Floor Disorders Week, sponsored by the American Urogynecologic Society.

“Based on our findings, 95% of patients with stress urinary incontinence will be missed on testing if abdominal pressure does not exceed 70 cm of water on the cough stress test,” said Dr. Trye, who is at Northwell Health, New Hyde Park, N.Y. In order to minimize false negatives, urodynamic operators should encourage patients to cough hard enough to exceed about 120-127 cm H₂O in abdominal pressure, she said.

^{Amy Karon/Frontline Medical News}

Dr. Sudhi Trye

Patients were asked to cough at least three times with increasing force at volumes of 200 mL, 300 mL, 400 mL, and 500 mL. The median minimum abdominal leak point pressure ranged from 120 to 127 cm H₂O, regardless of bladder volume, and did not differ significantly between premenopausal and postmenopausal women, Dr. Trye said. Only 5% had leakage at abdominal pressures of 70 cm of H₂O or less. The same was true at the other end of the spectrum – only 5% of women had leakage at abdominal pressures above 200 cm H₂O.

A total of 70% of patients were white; mean age was 65 years, with a standard deviation of 13.6 years; and average body mass index was 28.2 kg/m² with a standard deviation of 5.4 kg/m².

Although the findings merit replication in a larger and more diverse cohort, they suggest that patients should be encouraged to cough hard enough to achieve abdominal pressures above 120-127 cm H₂O, Dr. Trye said. Since many patients have trouble coughing this hard, operators should model it rather than just tell patients to cough, she added.

Dr. Trye reported having no financial disclosures. One coinvestigator reported ties to Kimberly-Clark and Boston Scientific.