These words, or something like them were first uttered by Humpty Dumpty in Lewis Carroll's Alice in Wonderland. For over three decades, the academic community has been admonished to take their heed by Richard Turner Warwick.
Virtually all articles on urinary incontinence report results in terms of cure, improvement and failure. Of course, we all know what cure of incontinence means, it means the patient is no longer incontinent. Well, not exactly. In most studies of the surgical treatment of stress incontinence, cure means that the patient no longer has stress incontinence, but the patient may have incontinence due to an overactive detrusor. The patient is still wet, but at least she's cured.
When a patient is cured of incontinence, it means that it is gone, it doesn't come back. Well, not exactly. In most studies of medications, biofeedback and periurethral injectables, it means that the patient is not incontinent for the duration of the study (sometimes a whole month or more). Some protocols have actually defined cure as being dry "at some point in time."
How do we know if a patient is cured of incontinence? Do we just ask her? Is she telling the truth? Who should ask her? Should we believe her? Recently, there have been well done, prospective clinical trials which document a marked disparity between the results of chart reviews, anonymous questionnaires, independent researcher interviews and treating physician interviews.
How do we know if a patient is cured? What are the role of diaries and pad tests? Urodynamics? What if a patient says she is never wet, but she leaks on examination with a full bladder or the pads show 4 ml of urinary loss in a 24 hour period.
In order to answer these questions, we must ask them. There are (at least) two ongoing efforts to pose such questions by the International Continence Society and the Urodynamic Society. In the current issue of this Journal there are two reports from the Urodynamic Society which seek to address them ("Standards of Efficacy for Evaluation of Treatment Outcomes in Urinary Incontinence: Recommendations of the Urodynamic Society" and "Definition and Classification of Urinary Incontinence: Recommendations of the Urodynamic Society") and an announcement from the ICS ("The Standardized Committee of the International Continence Society"). The efforts of the ICS and the Urodynamic Society are to be applauded; but, it is the responsibility of editors, peer reviewers, granting and regulatory agencies and ultimately the scientific community at large to insure that studies which address these issues do so in a scientifically compelling way by adhering to such standards. This requires a standardized lexicon and a minimal stan-