A 53-year-old postmenopausal woman, G3P3, presents for evaluation of new onset urinary leakage for the past 6 weeks.
Which of the following is the most appropriate first step in this patient’s evaluation?
A. Urinalysis and culture testWhen patients present with urinary incontinence, a urinalysis and culture tests should be performed to evaluate for acute cystitis. In patients diagnosed with a UTI, treatment should be initiated, and then the patient should be reevaluated. It is not uncommon for symptoms of urinary leakage to resolve after appropriate therapy. After obtaining the history and physical examination and evaluating a urinalysis and urine culture, only a few clinical tests are necessary in the initial evaluation of the incontinent patient. Most women with incontinence can begin conservative treatment based on history and examination alone. However, further conservative evaluation may include a PVR urine volume, cough stress test, and urinary diary. A PVR is determined by bladder catheterization after the patient has voided; when a large amount of urine remains after voiding, infection and incontinence may result. A cough stress test is performed by filling the bladder with fluid, asking the patient to cough or Valsalva, and directly visualizing the urethra to see if there is leakage.