ORIGINAL ARTICLE The “1-3-5 cough test”: comparing the severity of urodynamic stress incontinence with severity measures of subjective perception of stress urinary incontinence Themos Grigoriadis 1 & George Giannoulis 2 & Dimitris Zacharakis 1 & Athanasios Protopapas 2 & Linda Cardozo 3 & Stavros Athanasiou 1 Received: 10 May 2015 /Accepted: 20 July 2015 # The International Urogynecological Association 2015 Abstract Introduction and hypothesis The purpose of the study was to examine whether a test performed during urodynamics, the B1-3-5 cough test ^, could determine the severity of urodynamic stress incontinence (USI). Methods We included women referred for urodynamics who were diagnosed with USI. The B1-3-5 cough test^ was per- formed to grade the severity of USI at the completion of filling cystometry. A diagnosis of Bsevere^, Bmoderate^ or Bmild^ USI was given if urine leakage was observed after one, three or five consecutive coughs respectively. We examined the associations between grades of USI severity and measures of subjective perception of stress urinary incontinence (SUI): International Consultation of Incontinence Modular Question- naire—Female Lower Urinary Tract Symptom (ICIQ- FLUTS), King’ s Health Questionnaire (KHQ), Urinary Dis- tress Inventory-6 (UDI-6), Urinary Impact Questionnaire-7 (UIQ-7). Results A total of 1,181 patients completed the ICIQ-FLUTS and KHQ and 612 completed the UDI-6 and UIQ-7 question- naires. There was a statistically significant association of higher grades of USI severity with higher scores of the incon- tinence domain of the ICIQ-FLUTS. The scores of the UDI-6, UIQ-7 and of all KHQ domains (with the exception of general health perception and personal relationships) had statistically significant larger mean values for higher USI severity grade. Groups of higher USI severity had statistically significant as- sociations with higher scores of most of the subjective mea- sures of SUI. Conclusions Severity of USI, as defined by the B1-3-5 cough test^, was associated with the severity of subjective measures of SUI. This test may be a useful tool for the objective inter- pretation of patients with SUI who undergo urodynamics. Keywords 1-3-5 cough test . Questionnaires . Severity grading . Stress urinary incontinence . Urodynamic stress incontinence Introduction The Joint Report on the Terminology for Female Pelvic Floor Dysfunction of the International Urogynecological Associa- tion (IUGA) and the International Continence Society (ICS) defines stress urinary incontinence (SUI) as the complaint of involuntary loss of urine on effort or physical exertion or on sneezing or coughing [1]. As the severity of the subjective perception of SUI differs among women, a number of health measures have been introduced to record, quantify and stratify the severity of SUI, including measures of symptom severity, impact on quality of life and measures of the degree of bother on performance of daily activities [2]. The above-mentioned report defines urodynamic stress incontinence (USI) as the involuntary leakage of urine during filling cystometry, associ- ated with increased intra-abdominal pressure, in the absence of a detrusor contraction [1]. Since the mid 1980s various urodynamic parameters [3, 4], mainly concerning urethral function, have been evaluated to identify and quantify the * Themos Grigoriadis tgregos@yahoo.com 1 Urogynaecology Unit, First Department of Obstetrics and Gynecology, University of Athens, BAlexandra Hospital^, Lourou 1 Str, Athens 11528, Greece 2 First Department of Obstetrics and Gynecology, University of Athens, BAlexandra Hospital^, Lourou 1 Str, Athens 11528, Greece 3 Department of Urogynaecology, King’ s College Hospital, Denmark Hill, London Int Urogynecol J DOI 10.1007/s00192-015-2808-4