Value of Leak Point Pressure Study in Women With Incontinence

Abstract

We assessed the relationship between cough leak point pressure and Valsalva leak point pressure with stress incontinence and detrusor overactivity. This prospective study was performed on 109 women with urinary incontinence who underwent urodynamic assessment from December 2003 to June 2005. We recorded cough leak point pressure and Valsalva leak point pressure by asking the patient to cough and to perform a Valsalva maneuver at maximum cystometric capacity until urine loss was directly observed and recorded by the machine. Women with normal urodynamic results or spontaneous voiding during examination were excluded fro analysis. Results were entered in the urodynamic database and analyzed using SPSS(R) release 13.0. Of the 109 women in the study 61 (56%) had stress incontinence, 21 (19%) had detrusor overactivity and 27 (25%) had mixed incontinence. All women with stress incontinence demonstrated leak at cough leak point pressure but 40 women (66%) did not leak with the Valsalva maneuver. Of the 21 patients who had detrusor overactivity 16 (76%) did not leak at cough leak point pressure whereas 17 (81%) leaked with the Valsalva maneuver. In the group of 27 women with mixed incontinence all leaked with cough at cough leak point pressure but only 17 (63%) leaked with the Valsalva maneuver. Women with stress incontinence diagnosed with urodynamics leaked more at cough leak point pressure than the Valsalva maneuver, and women with detrusor overactivity leaked less at cough leak point pressure and more with the Valsalva maneuver.