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Our objective was to determine the availability and utilization of urodynamic investigations by gynecologists in the preoperative evaluation of women with urinary incontinence. Gynecologists in the UK, USA, Australia, New Zealand and Canada were asked what urodynamic investigations were required for four clinical scenarios. Analysis was restricted to frequent operators. Urodynamic investigations were available to 70% of frequent operators. For uncomplicated stress incontinence, cystometry was utilized by 72% of subspecialists and 44% of generalists ( P

The value of vaginal cones for genuine stress incontinence was assessed in 34 women with this condition. Subjective and objective assessments were made before and after 6 weeks of treatment using urinary diaries, perineometry, 'home' pad test and cone weights with and without voluntary pelvic floor contraction. There was a subjective improvement in 23 of the 34 women (68%) after 6 weeks of cone use with 16 (47%) deciding that no additional treatment other than cone therapy was required at this time. Statistical analyses showed that there were significant improvements in the objective indices. There were no side-effects observed with cone use. When followed up 12-24 (mean 15.8) months from the start of the study, 14 women (41%) were still improved with either cone or pelvic floor exercises. Vaginal cones would seem to be a simple and practical means of improving both pelvic floor strength and genuine stress incontinence.