Pad Weight Testing in the Evaluation of Urinary Incontinence

ABSTRACTThe teaching module “Pad Weight Testing in the Evaluation of Urinary Incontinence” was prepared by a Working Group of the ICS (International Continence Society) Urodynamics Committee. The module includes a PowerPoint presentation describing testing requirements, clinical workup, and analysis and is available at http://www.icsoffice.org/eLearning. The associated article evaluates pad testing, summarizes current evidence, and provides recommendations. Where evidence is unavailable or no consensus exists, expert opinion is given.The pad test provides a noninvasive diagnostic option for urinary incontinence (UI) that is easy to perform and inexpensive. When results are correlated with patient questionnaires or other diagnostic information, and the test is used appropriately, it has clear value in initial diagnosis, selection of treatment, and follow-up evaluation. Surveys have reported that that less than10% of urologists use the pad test routinely in their practice. Various testing durations and protocols have been reported, but only the 1-hour pad test has a standardized protocol. One-hour pad tests provide qualitative information and are useful during initial workup to select treatment and estimate prognosis for cure. Twenty-four-hour and longer testing quantifies the degree of urine leakage.One-hour pad testsPatients perform a set of specified ”physical activities before testing. These include the followingstanding up from a sitting position, vigorous coughing, running on the spot, bending to pick up an object from the floor, and washing hands in running water. The specified activities can be modified for patients with physical limitations. Because results are affected by a number of factors, too much weight should not be given to a negative 1-hour test. Repeated 1-hour pad tests are recommended especially when the test result does not correlate with subjective assessment provided by patient questionnaires.Twenty-four pad testsThe quantitative information provided by a 24-hour test gives an estimate of the amount of urine leakage and is useful for evaluation of treatment outcomes; this and longer pad tests are used in clinical studies. Results of testing depend on patient compliance, fluid intake, physical activity levels, hormonal status, and sexual activity, as well as environmental factors (temperature, humidity). Outcome is also influenced by the type of pad used, leakage, and evaporation. Therefore, pads should be exchanged every 4 to 6 hours