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Correlation of Valsalva leak point pressure with subjective degree of stress urinary incontinence in women.
J Urol. 1996 Jan; 155(1):281-5.JU

Abstract

PURPOSE

We correlated symptoms of stress urinary incontinence in women with intrinsic urethral function, as measured by Valsalva leak point pressure. In addition, we assessed the effects of urethral hypermobility, baseline resting abdominal pressure, patient age and menopausal status on Valsalva leak point pressure.

MATERIALS AND METHODS

We evaluated 64 consecutive women (mean age 50 years, range 20 to 79) with complaints of stress urinary incontinence. Initially the patient history was obtained and the subjective degree of stress urinary incontinence was graded as 1, 2 or 3 according to the SEAPI-QMN classification. Multichannel video urodynamics were then performed. At a volume of 150 to 200 ml. (or half bladder capacity when functional capacity was less than 150 ml.) filling was stopped. Resting, coughing and progressive Valsalva maneuvers were performed to determine Valsalva leak point pressure and the presence of urethral hypermobility. Valsalva leak point pressure was defined as the minimum total vesical pressure required to cause urinary incontinence in the absence of a detrusor contraction. Urodynamics were completed and detrusor instability or stress induced instability was noted.

RESULTS

Of the 64 women 52 (81.3%) had stress urinary incontinence. The exact test for trend demonstrated a statistically significant difference in the number of patients with a Valsalva leak point pressure of 90 cm. water or less (p = 0.0002) and 60 cm. water or less (p = 0.0002) among the 3 symptom groups. There was no correlation between Valsalva leak point pressure and resting vesical (which equals abdominal) pressure, patient age or menopausal status, or urge incontinence or detrusor instability among the 3 groups.

CONCLUSIONS

The subjective degree of stress urinary incontinence can predict intrinsic urethral function as measured by Valsalva leak point pressure. Higher grades of stress urinary incontinence have a higher likelihood of a low Valsalva leak point pressure. Many women with grade 2 or 3 stress urinary incontinence have a Valsalva leak point pressure of 90 cm. water or less despite urethral hypermobility and they may have a component of intrinsic urethral deficiency.

Authors+Show Affiliations

Department of Urology, New York University Medical Center, New York, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

7490856

Citation

Nitti, V W., and A J. Combs. "Correlation of Valsalva Leak Point Pressure With Subjective Degree of Stress Urinary Incontinence in Women." The Journal of Urology, vol. 155, no. 1, 1996, pp. 281-5.
Nitti VW, Combs AJ. Correlation of Valsalva leak point pressure with subjective degree of stress urinary incontinence in women. J Urol. 1996;155(1):281-5.
Nitti, V. W., & Combs, A. J. (1996). Correlation of Valsalva leak point pressure with subjective degree of stress urinary incontinence in women. The Journal of Urology, 155(1), 281-5.
Nitti VW, Combs AJ. Correlation of Valsalva Leak Point Pressure With Subjective Degree of Stress Urinary Incontinence in Women. J Urol. 1996;155(1):281-5. PubMed PMID: 7490856.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Correlation of Valsalva leak point pressure with subjective degree of stress urinary incontinence in women. AU - Nitti,V W, AU - Combs,A J, PY - 1996/1/1/pubmed PY - 1996/1/1/medline PY - 1996/1/1/entrez SP - 281 EP - 5 JF - The Journal of urology JO - J Urol VL - 155 IS - 1 N2 - PURPOSE: We correlated symptoms of stress urinary incontinence in women with intrinsic urethral function, as measured by Valsalva leak point pressure. In addition, we assessed the effects of urethral hypermobility, baseline resting abdominal pressure, patient age and menopausal status on Valsalva leak point pressure. MATERIALS AND METHODS: We evaluated 64 consecutive women (mean age 50 years, range 20 to 79) with complaints of stress urinary incontinence. Initially the patient history was obtained and the subjective degree of stress urinary incontinence was graded as 1, 2 or 3 according to the SEAPI-QMN classification. Multichannel video urodynamics were then performed. At a volume of 150 to 200 ml. (or half bladder capacity when functional capacity was less than 150 ml.) filling was stopped. Resting, coughing and progressive Valsalva maneuvers were performed to determine Valsalva leak point pressure and the presence of urethral hypermobility. Valsalva leak point pressure was defined as the minimum total vesical pressure required to cause urinary incontinence in the absence of a detrusor contraction. Urodynamics were completed and detrusor instability or stress induced instability was noted. RESULTS: Of the 64 women 52 (81.3%) had stress urinary incontinence. The exact test for trend demonstrated a statistically significant difference in the number of patients with a Valsalva leak point pressure of 90 cm. water or less (p = 0.0002) and 60 cm. water or less (p = 0.0002) among the 3 symptom groups. There was no correlation between Valsalva leak point pressure and resting vesical (which equals abdominal) pressure, patient age or menopausal status, or urge incontinence or detrusor instability among the 3 groups. CONCLUSIONS: The subjective degree of stress urinary incontinence can predict intrinsic urethral function as measured by Valsalva leak point pressure. Higher grades of stress urinary incontinence have a higher likelihood of a low Valsalva leak point pressure. Many women with grade 2 or 3 stress urinary incontinence have a Valsalva leak point pressure of 90 cm. water or less despite urethral hypermobility and they may have a component of intrinsic urethral deficiency. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/7490856/Correlation_of_Valsalva_leak_point_pressure_with_subjective_degree_of_stress_urinary_incontinence_in_women_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5347(01)66619-9 DB - PRIME DP - Unbound Medicine ER -