Important aspects of anatomy, pathophysiology and diagnostic procedures for the therapy of female urinary incontinence

Many aspects of the pathogenesis of urinary incontinence are poorly understood. Most studies show good results for physical therapy for instance for pelvic floor exercises Md biofeedback. Unfortunately most of these studies lack an objective diagnostic and neurophysiological assessment. This could be one reason for the strongly divergent therapeutical Success rates reported (30 to 90%). We recommend the use of objective parameters, for instance the PAD test with standardized bladder volume and a neurophysiological and short urodynamic assessment as well as subjective parameters [satisfaction with the outcome of treatment measured with the VAS (visual analog scale), documentation of the changes in ADL (activities of daily living)] in future therapeutical studies. A more precise assessment of the pathological cause of the impairment will help to develop optimal therapeutic procedures. Because of poor documentation in the past the analysis of therapeutic failures and the decision if mono- or complex physiotherapy is more appropriate has not been possible. This aspect will become even more important as the cost-effectiveness of treatments becomes a more important issue.