Expanded Paper Towel Test: An Objective Test of Urine Loss for Stress Incontinence
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Neumann, P and Blizzard, CL and Grimmer, K and Grant, R, Expanded Paper Towel Test: An Objective Test of Urine Loss for Stress Incontinence, Neurouology and Urodynamics , 23, (7) pp. 649- 655. ISSN 0733-2467 (2004) [Refereed Article]
Aim: To investigate the repeatability of a short stress test of coughing and jumping (the expanded Paper Towel Test (PTT)) to quantify urine loss in stress incontinent adult women. Materials and Methods: In the laboratory, the reliability of two methods of measuring the size of the wet area, produced by a typical volume of water titrated onto paper towel was investigated and some absorbency properties of the brand of towel used were quantified. Thirty one women performed a provocative coughing and jumping test on consecutive days using a "perineal pad" of paper towel. The repeatability coefficient was calculated. Results: The provocative test was repeatable to within 2.8 ml of urine loss, but with the exclusion of one anomalous result, the repeatability improved to lie within 1 ml. The coefficient of variation (CV) for the between-method differences (computer scanning and graph paper) was 1.27%. A volume of 1 ml of water produced a wet area of 25.7 cm2. The range of measurable areas corresponded to volumes of 0.005-8 ml. Standardization of method is required because the size of the wet area differed by manufacturer of paper towel (P < 0.01, two products compared) and with time elapsed since titration (P < 0.01). Conclusions: The "expanded PTT" is a simple tool for quantification of urine loss (0.005-8 ml) in women to 72 years with stress incontinence. With a suggested modification, it should prove reliable for detection of between-visit differences of 1 ml. The reliability of the test is dependent upon the use of standard protocol and paper towel with known volume-area ratio. To improve clinical diagnosis, it can also be used with any brand of paper towel to confirm the sign of stress incontinence on exertion. © 2004 Wiley-Liss, Inc.
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