This study compared the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the 24-h pad test with other measures that assess severity of urinary loss in women with urodynamic stress incontinence (USI). Ninety-five women with primary or recurrent (secondary) USI were recruited. Assessment of the severity of urinary loss was made using the ICIQ-SF, a 24-h pad test, continence questionnaire, Stamey grade, and 3-day frequency volume diary. The relationship between these measures of incontinence severity was analysed. The mean age was 54 years (SD+/-12) and median parity 2 (IQR 1-3). In the primary USI group there was a strong correlation between the ICIQ-SF and the 24-h pad test (r=0.458, P =0.000). Both the ICIQ-SF (Kendall's' tau b=0.331, p =0.003) and 24-h pad test (Kendall's tau b=0.399, p =0.002) also correlated with the mean frequency of urinary loss on diary but not with the Stamey grade. No subjective or objective tests correlated with each other in women with secondary USI. These results demonstrate a good correlation between the 24-h pad test diary loss, and ICIQ-SF in women with primary USI. Because it also includes a measure of quality of life impact in a short user-friendly format, we suggest that the ICIQ-SF should have widespread applicability as an outcome measure in patients with stress incontinence.

The values for 'mild', 'moderate' and 'severe' urinary incontinence have not been determined for the 24-hour pad test. To define these values, a prospective observational study was performed on 110 women with the primary symptom of urinary incontinence. Consenting women performed two 1-hour pad tests one week apart, and seven 24-hour pad tests for seven consecutive days. The 1-hour pad test definitions for mild, moderate and severe were translated to centiles, and used to categorise the 24-hour test values. This revealed that the range for 'mild incontinence' was between 1.3 and 20 g, 'moderate incontinence' ranged from 21 to 74 g, and 'severe incontinence' was defined as 75 g or more in 24 hours. Severity of leakage was analysed in relation to urodynamic diagnosis, age, parity and pelvic floor muscle strength. Increasing severity was associated with increasing age and parity. Women with detrusor overactivity were most likely to have severe leakage. In conclusion, this study defines the three grades of severity for the 24-hour pad test, which may help to guide patients' choice between conservative and surgical treatment and is useful for stratified randomisation of controlled trial participants.

A prospective observational study was conducted in a tertiary urogynaecology unit in women with the primary symptom of urinary incontinence to assess the repeatability of the 24-hour pad test. One hundred and eight women undertook seven 24-hour pad tests over 7 consecutive days together with 7 simultaneous fluid and activity charts. The results were analysed collectively and according to urodynamic subsets. Repeatability was assessed by repeated measures analysis of variance and univariate analysis of variance for each urodynamic diagnosis group (USI, mixed and no USI). Variation between pad test weights over the 7 days was low, supporting good repeatability. The number of days of pad testing required to approximate the 7-day average was 3 days. However, a single 24-hour pad test correlated highly with the 7-day average (r=0.881) and was considered sufficient to gauge leakage severity.

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The response rate of 39% might limit the applicability of the results. However, our finding that women lose only 0.3 g of vaginal secretions in 24 hours is much lower than previously reported. This might arise from the use of a highly accurate beam balance and the recruitment of a large sample of women with widely varying ages. This result might lower the threshold for objective diagnosis of urinary incontinence and alters the pad test definition of 'cure'.

Women with Asian or Indian ethnicity, operative vaginal birth, persistent occipito-posterior position and rapid uncontrolled delivery of the fetal head were likely to sustain OASIS. Awareness of these factors may help to minimise the incidence of OASIS.

Objective To evaluate peri-operative morbidity, continence outcome and patient satisfaction in older women (65 years) compared with younger women undergoing tension-free vaginal tape. Design Case controlled study.Setting Tertiary Urogynaecology Unit.Sample Women undergoing tension-free vaginal tape for urodynamic stress incontinence between July 1999and July 2002 were included. Those with detrusor overactivity, voiding difficulty at urodynamics or requiring concomitant prolapse surgery were excluded. Methods Older women were case matched to a younger cohort for BMI, parity, mode of anaesthesia and whether it was a primary or secondary continence procedure. Main outcome measures Operative morbidity and continence outcome were assessed at six weeks. After a minimum six months follow up, patient satisfaction and continence outcome were assessed using the Genitourinary Treatment Satisfaction Score (GUTSS). Results The median hospital stay was one day and overall urinary tract infection rate was similar in both groups. Post-operative voiding difficulty rates were 3% in older versus 15% in younger women (P ¼ 0.09).At six weeks, 65% of older versus 79% of younger women were dry (P ¼ 0.2). At a median of 12 months, 15 (45%) of older versus 24 (73%) of younger women had no urinary symptoms (P ¼ 0.05). Median GUTSS scores for satisfaction with continence outcome were lower for older 90% compared with 100% in younger women (P ¼ 0.003). Conclusions Tension-free vaginal tape is an effective continence intervention in older women but has a lower continence satisfaction rate compared with younger women.

The incidence of OASIS in Asian women is significantly higher in a Western than in an Asian setting. In Asian women, perineal length and birthweight can affect the risk of OASIS at the time of vaginal delivery.