Women with urinary incontinence should be referred to a specialist

EDITOR,—Arnfinn Seim and colleagues give some useful reminders about improvements that can be achieved by treating urinary incontinence in women in general practice.1 At the end of their study, however, 80% of the women were still incontinent to some extent. It is interesting that only 16% of the patients were referred for specialist opinion. In the long term it may be better for patients to be referred for expert diagnosis and treatment, to avoid some of the long term financial and social burdens of prolonged incontinence.2 When the prospect is many years of incontinence (the youngest patient was only 20 years old) a referral to a specialist—who can perform urodynamic tests, make an accurate diagnosis, and devise a management plan—is preferable to making an unsupported diagnosis and providing treatment that may be inappropriate. Obtaining a good clinical history of bladder disorders is known to be difficult, so if treatment is to be based on the history alone then treatments that are effective in both common forms of incontinence (genuine stress incontinence and detrusor instability) are probably more appropriate—for example, pelvic floor exercises.3

The trial was undoubtedly performed by a team interested in this subject and method of treatment, and I suspect that the results would not be as good if the trial was repeated by a less enthusiastic set of practitioners. Although, as a hospital urogynaecologist, I would not like to see my urodynamic clinics overrun, I would like more than 20% of patients to become fully continent.