The Effect of Patient Position on Leak-Point Pressure Measurements in Women with Genuine Stress Incontinence

Abstract

The aim of this study was to determine the quantitative and qualitative effects of patient position on coughing and Valsalva leak-point pressure in women with genunie stress incontinence. Thirty-seven patients with genuine stress incontinence and 4 with mixed incontinence underwent multichannel urodynamics using a standardized protocol. Leak-point pressures were performed using 8 Fr microtip catheters placed in the bladder and vagina at a bladder volume of 250 ml in the supine, semirecumbent and standing positions. Urethral pressure profilometry was performed in the semirecumbent position at a bladder volume of 250 ml. The mean (range) age, and median (range) gravidity, parity, body mass index (BMI), and mean (range) Q-tip deflection angle were 61 years (36-80), 3 (1-8), 3 (1-6), 26 (22-30) and 55.8 degrees (25 degrees-80 degrees), respectively. The mean (+/- standard deviation) Valsalva leak-point pressures in the supine, semirecumbent and standing positions were 82 +/- 23, 73 +/- 24 and 63 +/- 22 cmH2O, respectively (P<0.001). The mean (+/- standard deviation) cough leak-point pressures also decreased as the patients were moved from the supine (98 +/- 29 cmH2O) to the semirecumbent (88 +/- 24 cmH2O) and standing positions (77 +/- 24 cmH2O) (P<0.001). The correlation between leak-point pressure and maximum urethral closure pressure was statistically significant and was dependent upon patient position and the provocative maneuver used.