Assessing variability of the 24-hour pad weight test in men with post-prostatectomy incontinence

Abstract

Purpose:Decision-making regarding surgery for post-prostatectomy incontinence (PPI) is challenging. The 24-hour pad weight test is commonly used to objectively quantify PPI. However, pad weight may vary based upon activity level. We aimed to quantify variability in pad weights based upon patient-reported activity.Materials and Methods:25 patients who underwent radical prostatectomy were prospectively enrolled. All patients demonstrated clinical stress urinary incontinence without clinical urgency urinary incontinence. On three consecutive alternating days, patients submitted 24-hour pad weights along with a short survey documenting activity level and number of pads used.Results:Pad weights collected across the three days were well correlated to the individual (ICC 0.85 (95% CI 0.74–0.93), p<0.001). The mean difference between the minimum pad weight leakage and maximum leakage per patient was 133.4g (95% CI 80.4–186.5). The mean increase in 24-hour leakage for a one-point increase in self-reported activity level was 118.0g (95% CI 74.3–161.7, p<0.001). Pad weights also varied significantly when self-reported activity levels did not differ (mean difference 51.2g (95% CI 30.3–72.1), p<0.001).Conclusions:24-hour pad weight leakage may vary significantly on different days of collection. This variation is more pronounced with changes in activity level. Taking into account patient activity level may enhance the predictive value of pad weight testing.

Strong correlation between standing cough test and 24‐hour pad weights in the evaluation of male stress urinary incontinence

“…However, this mirrors clinical practice, and groups have shown a correlation of perceived to documented PPD in this population . Our pad‐based assessments did not incorporate patient activity level on the day of collection, which other authors have demonstrated may impact 24‐hour pad test results . Still, this study represents the first prospective comparison of a standardized office‐based assessment of SUI severity to the more time‐consuming and challenging gold standard (24‐hour PPD).…”

Proposal of a new way to evaluate the external sphincter function prior male sling surgey

“…One interesting paper, Malik et al reported the variability of the pad test according to the amount of physical activity performed by the patient on the day of collection. According to the author, as higher the degree of physical activity on the day of collection the higher will be the pad test weight (23). This aspect reinforce our hypotheses that lower values in the pad test can lead to false “ideal” patients and the objective evaluation of sphincter function could help selecting patients to RTS surgery.…”

Does trunk muscle training with an oscillating rod improve urinary incontinence after radical prostatectomy? A prospective randomized controlled trial

“…The pads were changed by the patient, collected and weighed after 24 hours. 14 Data of 1- and 24-hour pad test were independently documented by a physiotherapist and a sports scientist and were recorded at the beginning and at the end of the three-week study period.…”