What is the First Step in a Patient With Troublesome Urinary Leakage?
A 53-year-old postmenopausal woman, gravida 3, para 3, presents for evaluation of troublesome urinary leakage 6 weeks in duration. Which of the following is the most appropriate first step in this patient's evaluation?
a.Urinalysis and culture
b.Urethral pressure profiles
Answer / Explanation:
[HIDE]The answer is a, Urinalysis and culture. When patients present with urinary incontinence, a urinalysis and culture should be performed. In patients diagnosed with a urinary tract infection, treatment should be initiated and then the patient should be reevaluated. It is not uncommon for symptoms of urinary leakage to resolve after appropriate therapy. After obtaining the history and physical examination and evaluating a urinalysis (including urine culture), initial evaluation of the incontinent patient includes a cystometrogram, check for residual urine volume, stress test, and urinary diary. A cystometrogram is a test that determines urethral and bladder pressures as a function of bladder volume; also noted are the volumes and pressures when the patient first has the sensation of need to void, when maximal bladder capacity is reached, and so on. Residual urine volume is determined by bladder catheterization after the patient has voided; when urine remains after voiding, infection and incontinence may result.