Dynamic urethral pressure measurements in the diagnosis of incontinence in women

Abstract

A group of 72 female patients whose incontinence had persisted despite various therapies was selected for an extensive urodynamic study. Overt neuropathy was absent in the patient group. An objectified history was taken and the patients were categorized accordingly. Filling cystometry and flow studies were performed in supine and standing positions, combined with continuous measurement of urethral pressure from three points within the urethra and EMG of the urethral and anal sphincters. Urethral pressure profiles were taken at rest and under stress conditions. The history indicated stress incontinence in 23 patients, urge incontinence in 33 and mixed incontinence in 16. Cystometry and urethral profile measurement alone confirmed the history in 80% of the stress and urge patients. Urethral pressure registration during filling, however, showed that a pathologic urethral function was involved in 40 patients (14 stress, 16 urge and 10 mixed incontinents) and, as a result, changed the therapeutic approach in these cases. This pathology was not clear from the EMG recordings or the urethral pressure profiles. Continuous measurement of the urethral pressure dynamics during cystometry can unveil pathology of the urethral function as the basic cause of incontinence and thus prevent inadequate therapies from being used for these patients.