Abdel-fattah M et al. (2004) The standard 1-hour pad test: does it have any value in clinical practice? Eur Urol 46: 377–380

The standard 1-hour pad test is a widely used, semiobjective method for assessing female urinary incontinence (UI). Under specific conditions, the woman wears a preweighed pad for 1 hour and then the pad is weighed again. An increase in pad weight of 1 gram or more indicates a positive result. Abdel-fattah et al. have investigated whether subjective assessment by the patient could replace this test in clinical practice.

Women awaiting surgery for stress incontinence (n = 90) were prospectively recruited. Preoperative continence status was assessed using the standard 1-hour pad test and by asking the patients to classify themselves as 'totally continent to urine', 'mild or occasional UI', 'moderate UI' or 'severe UI'. During the pad test, patients also completed the King's Health Questionnaire (KHQ) to measure quality of life. Assessments were repeated 4 months postoperatively in 70 cases, giving a total of 160 sets of results for analysis.

Subjective assessment of UI by the patient (incontinent vs continent) detected the pad test result (positive vs negative) with a sensitivity of 95.65% and a specificity of 93.33%. There was poor correlation, however, between the perceived severity of UI and the amount of pad gain. KHQ scores correlated better with patients' subjective assessments than with pad test results.

In conclusion, the authors suggest that time and resources could be saved by replacing the pad test with the patient's own assessment of their continence status.