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July 16, 2008

Diagnosis of Urinary Incontinence

JAMA. 2008;300(3):283. doi:10.1001/jama.2008.30

To the Editor: In a systematic review and meta-analysis, Dr Holroyd-Leduc and colleagues1 found that the most helpful component for diagnosis of urgency urinary incontinence is a history of urine loss with urgency and that a bladder stress test may be helpful for diagnosing stress urinary incontinence.

History-taking is the cornerstone of urinary incontinence assessment. However, another important and useful tool in clinical practice is the bladder diary, in which a patient is instructed to record the times of micturitions and voided volumes, incontinence episodes, pad usage, the degree of urgency and physical exercise during urinary leakage, and the degree of incontinence.2 The bladder diary provides an objective measure of a patient's lower urinary tract symptoms. It also mirrors day-to-day reality, whereas patients' symptoms often cannot be reproduced by clinical examination and urodynamic investigations because of the extraordinary situation and the time limits of a medical consultation.