Valsalva urethral profile (VUP): A urodynamic measure to assess stress urinary incontinence in women.

Abstract

We aimed to assess the value of the Valsalva urethral profile (VUP) in case of stress urinary incontinence (SUI). Six hundred and ninety-four women without pelvic organ prolapse were included in this prospective monocentric study. SUI was diagnosedfrom symptoms using the International Continence Society definition, and severity using two validated questionnaires (USP and ICIQ-SF). The urodynamic parameters studied were maximal urethral closure pressure (MUCP) and functional length (FL). Both were performed at rest, during a Valsalva maneuver (v-MUCP and v-FL) and again at rest. Correlation analyses and ROC curves were used to assess the value of the clinical and urodynamic measurements. In our population, based on the questionnaires, 172 (24.8%) women were diagnosed with pure SUI on symptoms, 71 (10.2%) with urgency urinary incontinence and 392 (56.5%) with mixed urinary incontinence; 59 (8.5%) women were continent. The v-MUCP was the most correlated parameter to the severity of SUI (ρ: -0.63) and the most predictive of SUI risk, with a threshold value of 35 cm H2 O (Se = 0.82, Sp = 0.86). The v-FL was significantly shortened in case of SUI. The v-MUCP and v-FL are global measurements of urethral resistance during stress. With a threshold value of 35 cm H2 O, the v-MUCP was the most discriminating parameter for the diagnosis of SUI, with a good reliability.