VARIATIONS IN VALSALVA LEAK POINT PRESSURE WITH INCREASING VESICAL VOLUME
Abstract
Purpose:
Although leak point pressure testing is a valuable tool in the diagnosis of female stress urinary incontinence, little standardization in methodology exists. We examined the effect of vesical volume on leak point pressure to assess the need for determining an optimal volume for leak point pressure testing.
Materials and Methods:
Video urodynamic testing was performed in 52 consecutive women with a mean age of 52 years who presented with stress urinary incontinence. By fluoroscopic criteria stress urinary incontinence was type I in 12 patients, type II in 20 and type III in 20. Leak point pressure determined at 50 cc volume increments was correlated with fluoroscopic criteria.
Results:
Women with type I stress urinary incontinence had high leak point pressure, which remained high at increasing vesical volumes, and those with type III had low leak point pressure, which remained low at increasing volumes. In patients with type II incontinence initially high leak point pressure decreased significantly at increasing vesical volumes. The most appropriate classification of patients occurred at a volume of 250 to 300 cc.
Conclusions:
Leak point pressure is affected by vesical volume. At a volume of 250 to 300 cc leak point pressure correlates best with fluoroscopic findings, and it may be used to guide therapy in women presenting with stress urinary incontinence.
References
- 1 : Stress incontinence: classification and surgical approach. J. Urol.1988; 139: 727. Link, Google Scholar
- 2 : Stress incontinence. Obst. Gynec.1976; 47: 255. Medline, Google Scholar
- 3 : The Raz bladder neck suspension: results in 206 patients. J. Urol.1992; 148: 845. Link, Google Scholar
- 4 : Endoscopic injection of glutaraldehyde cross-linked collagen for the treatment of intrinsic sphincter deficiency in women. Urology1995; 46: 378. Crossref, Medline, Google Scholar
- 5 : Experience with pubovaginal slings for urinary incontinence at the University of Michigan. J. Urol.1987; 138: 525. Link, Google Scholar
- 6 : Pubovaginal fascial sling for the treatment of complicated stress urinary incontinence. J. Urol.1991; 145: 1214. Link, Google Scholar
- 7 : Clinical assessment of urethral sphincter function. J. Urol.1993; 150: 1452. Link, Google Scholar
- 8 : Leak-point pressures. Urol. Clin. N. Amer.1996; 23: 253. Crossref, Medline, Google Scholar
- 9 : Observer variability in stress leak point pressure measurement using fluorourodynamics. J. Urol., part 21995; 153: 492A. abstract 1056. Google Scholar
- 10 : Leak point pressures in women with urinary stress incontinence: correlation with patient history. J. Urol.1997; 157: 818. Link, Google Scholar
- 11 : Valsalva leak point pressures in women with genuine stress incontinence: reproducibility, effect of catheter caliber, and correlations with other measures of urethral resistance. Continence Program for Women Research Group. Amer. J. Obst. Gynec.1995; 173: 551. Crossref, Medline, Google Scholar
- 12 : The effect of vesical volume on Valsalva leak point pressures in women with genuine stress urinary incontinence. Obst. Gynec.1996; 87: 711. Crossref, Medline, Google Scholar
- 13 : A critical appraisal of the methods of measuring leak point pressures in women with stress incontinence. Obst. Gynec.1995; 86: 349. Crossref, Medline, Google Scholar
- 14 : Urodynamic evaluation of stress incontinence. Urol. Clin. N. Amer.1995; 22: 551. Crossref, Medline, Google Scholar
- 15 : Endoscopic collagen injection therapy in elderly women with type I stress urinary incontinence. J. Urol.1996; 155: 512. Link, Google Scholar
From the Section of Urology, University of Michigan, Ann Arbor, Michigan
