The relationship between urinary symptom questionnaires and urodynamic diagnoses: an analysis of two methods of questionnaire administration

Objective: To assess whether method of administration of a standard urinary symptom questionnaire alters the relationship of symptoms with urodynamic diagnoses. Design: Randomised crossover study. Setting: Tertiary Urogynaecology Unit, London, UK. Participants: One hundred and fourteen women attending a tertiary urogynaecology clinic. Methods: Women were randomised to either an initial interview-assisted questionnaire in the clinic with a follow up postal questionnaire or an initial pre-outpatient questionnaire followed by an interview-assisted questionnaire at the clinic visit. Videocystourethrography or saline cystometry was performed at the clinic visit. Main outcome measures: Question responses were compared with urodynamic diagnoses. Results: With an interview method, only severity of incontinence was significantly associated with detrusor overactivity (U = 593.5, P = 0.012). With self-completion, severity of nocturia (U = 477, P < 0.05), urgency (U = 395, P = 0.003), urge urinary incontinence (U = 392, P = 0.003), leakage without warning (U = 443, P = 0.035) and incomplete voiding (U = 413, P = 0.01) were significantly associated with detrusor activity. On interview the symptom of stress urinary incontinence (U = 523, P = 0.002) and use of pads (U = 564.5, P = 0.011) were significantly associated with a diagnosis of urodynamic stress incontinence. Severity of stress urinary incontinence (U = 276, P < 0.001), frequency of leakage (U = 348.5, P = 0.004), use of protection (U = 432.5, P < 0.018), nocturnal incontinence (U = 393.5, P = 0.002) and quantity of leakage (U = 441.5, P < 0.05) on self-completion were strongly associated with diagnosed urodynamic stress incontinence. There was no association between the symptoms of urgency or urge incontinence and the urodynamic stress incontinence. Conclusions: Postal questionnaire responses have a better relationship with urodynamics, both for urodynamic stress incontinence and detrusor over activity, than interview-assisted questionnaire responses. However, no symptom has a high enough specificity and sensitivity to replace urodynamic testing.