The urodynamic investigation of choice to distinguish stress urinary incontinence (SUI) from overactive bladder (OAB) and confirm genuine stress incontinence before planning surgical intervention is:

• A Uroflowmetry
• B Pad test (24-hour)
• C Post-void residual measurement by ultrasound
• D Cystometry with pressure-flow studies (multichannel urodynamics) ✓

Explanation

Multichannel cystometry (subtracted cystometry with simultaneous vesical and abdominal pressure measurement) is the gold-standard urodynamic investigation. It allows differentiation of: (1) genuine stress incontinence — involuntary leakage on raised abdominal pressure with no detrusor contraction (urodynamic stress incontinence, USI); (2) detrusor overactivity (OAB) — involuntary detrusor contractions during filling; (3) mixed incontinence. Confirmation of USI by urodynamics is recommended before invasive surgical treatment (mid-urethral slings, colposuspension) to avoid operating on detrusor overactivity presenting as SUI.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.