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The multiplicity of factors involved in the diagnosis and treatment of Urinary Incontinence in women, known for several decades, have been along the years target of extensive studies, which studies reflect in the most adequate attendance to the incontinent women and in better therapeutic results.
There exists a positive correlation between the index of corporeal mass (ICM) and the prevalence of Urinary Incontinence 9,10.
Our findings confirm the previous quoted affirmations where, the index of the corporeal mass was significantly larger in the group of incontinent women, compared to continent women.
The information obtained by the clinical History showed a positive predictive value of approximately 70% for stress Urinary Incontinence, not being able to make this evaluation in patients carriers of urgency Urinary Incontinence, reinforcing, in these cases, the need of making complementary exams 11,12 . So, the History is not reliable to reach a precise diagnosis. This is due mainly to the fact that the symptoms of the Urinary tract usually superpose and are not specific. In relation to the information obtained by the clinical History, we can, according to our findings, raise a few significant questions in this kind of evaluation. When we analyze the number of daily urinations in the group of incontinent women compared to the continent group we observe a larger number of urinations in the incontinent group. But, when compared to the sub group of incontinent women we do not find significant statistical differences showing that the number of urinations cannot be used to differ those women with stress Urinary Incontinence with the women with urgency.
In spite of the difference observed in the number of urinations in the continent and incontinent group, when we analyze the quantity of liquid ingested in a day there was a variation between incontinent women and normal, there existed significant statistical differences between the incontinent patients where the ones that suffer from Incontinence by urgency ingest less liquids than those with stress Incontinence, probably to avoid a greater amount of loss episodes.
When we correlate the presence of nicturia between the studied women we notice that incontinent women show a larger number of nightly urinations than the continent women.
The presence of vaginal prolapses and infections of the Urinary tract and previous gynecological surgeries were described by several authors 3,13 as predisponent factors of Urinary Incontinence, which was confirmed in this study where 52.9% of incontinent women showed genital prolapse and in 64.7% of these women previous Urinary infections were contacted and 72.5% had previous gynecological surgeries, being that in the continent women the values were respectively 6% and 32%, being that none of them had been submitted to any previous gynecological surgery, having a significant statistical difference.
We evaluated with the urination interruption test the capacity of contraction and musculature strength of the pelvic floor to interrupt the Urinary flow and we noticed that only 25.5% of the incontinent patients possessed a capacity of interrupting the Urinary flow and, among these 22.7% of the ones that suffered stress Incontinence could totally interrupt and only 3.4% of those that suffered form urgency Incontinence did it. Among the normal women 80% were capable of interrupting totally the Urinary flow showing a significant statistic difference in the muscular capacity of these women.
We observed comparing the results of the subjective evaluation (questionnaire) and objective (pad test), that there is a concordance between both evaluation modalities in 56.86% of the cases and that in 41.18% the data was overrated by the subjective evaluation and that only 1.96% of the cases the data of the objective evaluation were overrated. These show clearly that the individual perception of Urinary loss can, in some situations, be larger than the Urinary loss really demonstrable.
The reproducibility of the pad test in our study was good in accordance with the findings of other authors 7,14. Nevertheless, we observed a significative variation of the result of this test in the same individual when repeated several times 15. Despite the assurance of this test being controversial, we observed that it may give us important information in the diagnosis and in the evaluation of Urinary Incontinence, before or after treatment, being clinical or surgical.