Exploration Essential before Stress Urinary Incontinence Surgery

This is a review on the necessary explorations before performing a surgical procedure for stress urinary incontinence (SUI). These explorations must meet three objectives:1. Affirm the diagnosis of SUIThe diagnosis of SUI can be easy if it is pure, but half of them are associated with overactive bladder symptoms. The useful and indispensable tools to affirm this diagnosis, besides a well conducted examination are:- Symptom questionnaires (USP, MHU) and impact on quality of life (question 5 ICIQ);- The voiding diary on 3 days;- A clinical examination performed in good conditions, allowing to visualize the leaks related to stress test (cough, abdominal straining).2. Checking the absence of others urinary disorders that may alter the indication and/or the prognosisLow stream often underestimated by the patient. A genital prolapse that may be asymptomatic. The essential tools to evaluate these other disorders are:- A uroflowmetry with a post-voiding residual measure;- A clinical examination to check a possible génital prolapse;- Urodynamic study in case of urinary disorders associated with SUI or complex situation.3. Specify the mechanism of incontinence:A. Urethral hypermobility: Urethral mobility to cough and/or abdominal straining. Simulation of the effect of a sub-urethral tape by support test witch is positive if it makes disappear the leaks.B. Intrinsic sphincter deficiency: The absences of mobility of the urethra, leaks during abdominal staining or with the introduction of a vaginal speculum, a negative urethral support test are signs of intrinsic sphincter deficiency. The tools needed to clarify the mechanisms are:- Clinical examination evaluating the mobility of the urethra;- Urodynamic assessment with sphincterometry in case of doubt about the existence of intrinsic sphincter deficency or detrusor overactivity.