Cough Leak Point Pressure Research Articles

Clinical significance of anatomical urethral length on stress urinary incontinence women.

ObjectiveTo evaluate the association between the length of the female urethra and urodynamic study (UDS) parameters in patients presenting with stress urinary incontinence (SUI).Patients and methodsWe retrospectively enrolled 391 women who underwent a transobturator adjustable tape sling implantation for the management of SUI between April 2009 and March 2016. All patients underwent a physical examination and UDS. Filling cystometry data that were evaluated included the Valsalva leak point pressure, and the cough leak point pressure. The maximal urethral closure pressure, the functional urethral length (FUL), and the length of the continence zone (LCZ) were measured using the urethral profile obtained from the UDS. The anatomical urethral length (AUL) was measured intraoperatively using a Foley catheter. We calculated the LCZ/FUL ratio to determine the anatomical continence length for this study.ResultsWe noted that 299 patients completed the study. The mean AUL was 26.25±3.59 mm. The mean FUL and LCZ were 41.37±15.05 mm and 24.15±13.90 mm, respectively. The mean LCZ/FUL was 0.57±0.19. Using the Pearson correlation coefficient, we observed that the AUL showed a correlation with the FUL (0.168, P=0.034), the LCZ (0.212, P=0.007), the LCZ/FUL ratio (0.190, P=0.016), the Valsalva leak point pressure (0.223, P=0.005), the cough leak point pressure (0.215, P=0.006), and the maximal urethral closure pressure (0.178, P=0.043).ConclusionOur results show that the AUL in women is associated with UDS parameters relating to SUI.

Intraoperative Observation of the Degree and Pattern of Urine Leakage before Adjustment of the Mesh during a Transobturator Tape Procedure.

Most intraoperative provocative tests previously reported were performed after mesh adjustment to confirm the absence of urine leakage. Instead, our test was performed before adjustment of the mesh to control the tape tension after observing the pattern of the urine leakage. We studied whether this method had an effect on the success rate of transobturator tape (TOT) procedures. A total of 96 patients were included: 47 patients underwent TOT procedures without intraoperative testing (Group I) and 49 patients underwent TOT procedures with testing (Group II). Bladder filling was performed with at least 300 ml of normal saline during the test. After observing the pattern of the urine leakage before adjustment of the mesh by coughing or manual pressure on the suprapubic area, we controlled the mesh tension. In Group I, which did not undergo the intraoperative test, the Valsalva leak-point pressure, cough leak-point pressure, preoperative and postoperative peak flow velocity (Qmax), and postvoiding residual urine (PVR) were 86.46 cmH2O, 101.91 cmH2O, 20.82 ml/s, 22.74 ml/s, 19.77 ml, and 45.98 ml, respectively. Changes in the postoperative and preoperative Qmax and PVR were 1.92 ml/s and 26.21 ml, respectively. In Group II, in which the test was applied, the corresponding results were 85.50 cmH2O, 100.45 cmH2O, 25.60 ml/s, 26.90 ml/s, 17.16 ml, and 29.67 ml, respectively. Changes in the postoperative and preoperative Qmax and PVR were 1.3 ml/s and 12.51 ml, respectively. The two groups showed no significant differences in any of the variables. In Group I, the cure and improvement rates were 70.2% and 27.7%, respectively. In Group II, the rates were 91.8% and 8.2%, respectively. Group II had a significantly higher success rate than Group I (p value= 0.011). In the univariable logistic regression analysis, Group II exhibited a higher odds ratio (4.771) than Group I in terms of cure rate, and Group II had a higher success rate than Group I (p value=0.011). In the multivariable logistic regression analysis, Group II exhibited a higher odds ratio (4.700) than Group I in terms of cure rate under calculation of the variables (namely, age, hypertension, preoperative Qmax, and PVR), and the cure rate of Group II was verified to be significantly higher than that of Group I (p value=0.019). We suggest that our test is an effective method to confirm whether adequate tension is being applied to the tape. Our method presents some advantages in that surgeons can control and adjust the tension of the mesh after observing the degree and pattern of the urine leakage.

Obesity and smoking: Are they modulators of cough intravesical peak pressure in stress urinary incontinence?

SUI (Stress Urinary Incontinence) results from sudden increases in intravesical peak pressures exceeding urethral resistance leading to involuntary urine loss. Obesity and smoking are well established reversible risk factors for SUI and may alter intravesical peak pressures. BMI, smoking status, and other clinical factors were studied to determine their relationship to CIPP (maximal Intravesical Peak Pressures generated by Cough) in SUI complaining women. Three hundred nineteen women complaining of SUI were evaluated with medical history and urodynamics. Age, parity, comorbidities, previous surgery, BMI and history of smoking were obtained. The maximal intravesical peak pressures generated by cough (CIPP) and cough leak point pressure (CLPP) were acquired. Univariate and multivariate analysis were conducted. Current smokers and former smokers had similar CIPP (170cmH₂O and 170cmH₂O; p = 0.5, respectively); Those individuals who had never smoked had significantly lower CIPP (140cmH₂O; p = 0.000 and p = 0.009 respectively). BMI was directly related to CIPP (r = 0.41; p = 0.000). Vaginal deliveries (r = -0.15, p = 0.08) and diabetes (r = 0.15, p = 0.016) were also directly related to CIPP on univariate analysis. Only smoking status (p = 0.000) and BMI (p = 0.000) were independently significantly related to CIPP on multivariate analysis. Obesity and smoking showed increased CIPP (maximal Intravesical Peak Pressures generated by Cough). While reduced BMI is related to lower CIPP, smoking cessation does not appear to diminish CIPP. These findings suggest that weight loss may reduce incontinence by CIPP modulation. However, the benefits of smoking cessation without additional lifestyle modification, may have no benefit to improve urinary incontinence.

The association of Incontinence Symptom Index scores with urethral function and support

The objective of this study was to establish categories of symptom severity based on Incontinence Symptom Index (ISI) scores and to show how these categories are associated with urethral function and support. Women with stress incontinence (n = 97) and asymptomatic controls (n = 98) completed the ISI. Asymptomatic women's scores were between 0 and 6; this range was designated as absent/mild (n = 104). The median score for symptomatic women was 16; scores from 7 to 16 (n = 50) were designated as moderate, and scores of 17 or greater (n = 40) were designated as severe. Urethral function differed in women with mild, moderate, and severe scores: Valsalva leak point pressure (162.3 vs 123.5 vs 101.9 cm H(2)O; P = .001), cough leak point pressure (202.0 vs 163.0 vs 134.3 cm H(2)O; P = .001), and maximum urethral closure pressure (69.1 vs 44.1 vs 35.3 cm H(2)O; P = .001). Loss of urethrovesical support (point Aa: -1.0 vs -0.6 vs -0.5 cm; P = .004) was found in women with moderate and severe symptoms, compared with those with mild symptoms. Categories of symptom severity assessed by the ISI are associated with urethral function and support.

Leak point pressure does not correlate with incontinence severity or bother in women undergoing surgery for urodynamic stress incontinence

The aim of this study was to correlate the lowest Valsalva or cough leak point pressure (LPP) with clinical measures of incontinence severity and quality of life in women with pure urodynamic stress incontinence (SUI). This is an analysis of the baseline data from a prospective, multicenter, randomized trial comparing the Monarc transobturator sling to the tension-free vaginal tape. One hundred fifty-five women with SUI underwent urodynamic evaluations including abdominal or vesical LPP determinations, and each completed the Sandvik Incontinence Severity Index, a 3-day voiding diary, and quality-of-life questionnaires. In patients with a LPP, there were no significant correlations between LPP and the above clinical measures of incontinence severity or condition-specific quality-of-life questionnaire scores. In this patient population with pure urodynamic SUI, LPP is not a useful urodynamic predictor of baseline SUI severity and its effects on quality of life.

Reliability testing of urodynamics, pressure flow studies and cough leak point pressure in women with urodynamic stress incontinence with and without detrusor overactivity

Urodynamic studies which included cough leak point pressure (CLPP) and pressure flow studies were performed at two visits 2 weeks apart. Reproducibility between the two visits and also between the two diagnostic groups, urodynamic stress incontinence (USI) and urodynamic mixed incontinence (UMI) were analysed. Thirty-one women completed both visits, of those 14 had USI in both sets of urodynamic studies, 11 had UMI on both visits, six had USI on one visit and UMI in the other. The urodynamic variables of maximum cystometric capacity and CLPP have the most repeatability. Analysis in women with USI alone compared to USI with detrusor overactivity (DOA) showed that the repeatability for pressure flow parameters and CLPP was better in women without DOA, of which the CLPP was significantly different (p = 0.036). Urodynamic variables are inconsistent. This may reflect variations in urinary tract behaviour.

Comparison of three disease-specific quality-of-life questionnaires (Bristol Female Lower Urinary Tract Symptoms, Incontinence Quality of Life and King's Health Questionnaire) in women with stress urinary incontinence

To examine the impact of stress urinary incontinence (UI) on quality of life (QOL) using three disease-specific QOL instruments and compare the results obtained with these instruments. A total of 28 women (age range 36-74 years) with stress UI were included in the study. To obtain QOL assessments, patients were asked to complete the Bristol Female Lower Urinary Tract Symptoms (BFLUTS), Incontinence Quality of Life (I-QoL) and King's Health Questionnaire (KHQ) instruments. One domain in the BFLUTS (Incontinence symptoms) and one in the KHQ (Severity measures) correlated inversely with the Valsalva leak point pressure and the cough leak point pressure, respectively; however, other domains in the three questionnaires did not correlate with objective data. Two BFLUTS domains (Incontinence symptoms and QOL) correlated weakly or moderately with six KHQ domains; however, other BFLUTS domains did not correlate with most KHQ domains. Significant negative correlations were noted between two BFLUTS domains (Incontinence symptoms and QOL) and most I-QoL domains; however, other BFLUTS domains did not correlate with the I-QoL. Role limitations, Emotional problems and Severity measures in the KHQ correlated weakly or moderately with the I-QoL; however, General health and Personal relationships did not correlate significantly with the I-QoL. Subjective QOL results of stress UI using condition-specific QOL questionnaires may differ because there are a plethora of measurement instruments that vary in terms of their scope and content. Our findings suggest that, before deciding on an instrument, its contents should be thoroughly reviewed to ensure that a particular aspect of QOL does not need additional assessment.

Weak VLPP and MUCP correlation and their relationship with objective and subjective measures of severity of urinary incontinence

The aims of the present study were to find the correlation between Valsalva leak-point pressure (VLPP) and cough leak-point pressure (CLPP) and to determine whether the water perfusion maximum urethral closure pressure (MUCP) correlates with VLPP. Seventy-nine women with previously untreated stress urinary incontinence were recruited to participate in a clinical study. Their mean age was 56.4 years, mean BMI was 27.8, and mean parity was 1.9. The mean values of VLPP and CLPP were 50.4 and 52.9 cm H(2)O, respectively. We did not find statistically significant differences in the mean values of VLPP and CLPP. The mean value of MUCP at rest was 44.2 cm H(2)O and the mean value of MUCP during maximal Valsalva maneuver was 37.2 cm H(2)O; with 500 ml of sterile saline in the bladder the difference between them is statistically significant. In the study group (n=79), 56 patients (77%) had low VLPP (< or =60 cm H(2)O), 21 patients (30%) had low MUCP (< or =30 cm H(2)O), and 8 patients had MUCP< or =20 cm H(2)O (all at rest). Of the 56 patients with low VLPP, 16 also had a low MUCP (< or =30 cm H(2)O). This study mainly compares two parameters-the MUCP and the VLPP. Based on our results we can conclude that there is no correlation between these parameters. MUCP measures urethral resistance at rest and VLPP measures urethral resistance during increased intra-abdominal pressure (Valsalva maneuver).

Value of Leak Point Pressure Study in Women With Incontinence

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.

1310: Minimal Invasive Cough Leak Point Pressure (CLPP) Measurements Differentiates Between Patients with Pure Stress, Pure Urge or Mixed Incontinence

You have accessJournal of UrologyModerated Poster, Tuesday, May 24, 2005, 1:00 - 3:00 pm1 Apr 20051310: Minimal Invasive Cough Leak Point Pressure (CLPP) Measurements Differentiates Between Patients with Pure Stress, Pure Urge or Mixed Incontinence Sebastian Wille, Rolf von Knobloch, and Rainer Hofmann Sebastian WilleSebastian Wille More articles by this author , Rolf von KnoblochRolf von Knobloch More articles by this author , and Rainer HofmannRainer Hofmann More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)35455-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1310: Minimal Invasive Cough Leak Point Pressure (CLPP) Measurements Differentiates Between Patients with Pure Stress, Pure Urge or Mixed Incontinence." The Journal of Urology, 173(4S), p. 356 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 356 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Sebastian Wille More articles by this author Rolf von Knobloch More articles by this author Rainer Hofmann More articles by this author Expand All Advertisement PDF downloadLoading ...

ASSOCIATION BETWEEN VALSALVA AND COUGH LEAK POINT PRESSURES AND PELVIC ORGAN PROLAPSE QUANTIFICATION IN WOMEN WITH STRESS INCONTINENCE

Women with urodynamically documented stress urinary incontinence (SUI) and urethral hypermobility may have a higher pelvic organ prolapse quantification (POP-Q) stage according to anterior POP-Q measurements. In this study we determined if POP-Q system anterior components representing the urethrovesical junction (anterior wall point Aa/Ba) and/or POP-Q stage has a relationship with leak point pressure testing. Of the 1,511 women who underwent video fluoro-urodynamics during 1997 to 2003 at our institution 88 with only evidence of SUI with negative Valsalva leak point pressure and positive cough leak point pressure (CLPP) were selected. Average patient age was 58.6 years (range 32 to 89). Of the 88 women 82 had complete POP-Q examinations available, which revealed stages 0 to III in 21 (25.61%), 20 (24.39%), 40 (48.78%) and 1 (1.22%), respectively. The association between POP-Q stage/components and positive CLPP showed no significant difference in mean positive CLPP among POP-Q stages (p = 0.178) or components (p = 0.42 to 0.97). The test for linear trend was not significant (p = 0.636) for POP-Q stages/components (p = 0.40 to 0.93). No significant difference in volume at which positive CLPP occurred was observed among POP-Q stages (p = 0.283) or components (p = 0.13 to 0.75). The proportion of patients with leakage at 200 cc did not differ significantly among POP-Q stages (p = 0.119) or components (p = 0.15 to 0.60). Analysis of women with urodynamic evidence of SUI with negative Valsalva leak point pressure and positive CLPP did not show any significant association with components of the POP-Q system or with POP-Q stages. Findings support that POP-Q measurements should not be interpreted as indicators of urethral hypermobility when evaluating women with SUI.

365Minimal invasive cough leak point pressure (CLPP) measurements differentiates between patients with pure stress, pure urge or mixed incontinence

365Minimal invasive cough leak point pressure (CLPP) measurements differentiates between patients with pure stress, pure urge or mixed incontinence

EVALUATION OF MINIMALLY INVASIVE ANALYSIS SYSTEM FOR COUGH LEAK POINT PRESSURE MEASUREMENT

Leak point pressure (LPP) measurement has become standard in the diagnosis of stress urinary incontinence. Leak point pressure is determined by increasing abdominal pressure, which can be done with a Valsalva maneuver or coughing, that is Valsalva LPP and cough LPP (CLPP). It may be influenced by catheter size, bladder volume and interobserver variability. A new, computerized LPP measuring technique for routine use in daily urodynamic practice was tested at a female unit urodynamic practice to evaluate female urinary incontinence. A total of 28 female patients with a mean age of 54.07 years (range 23 to 82) and urinary incontinence underwent a new, minimally invasive measurement of the cough leak point. Measurements are made with the patient standing and repeated 3 times per patient. Additionally, parameters of the corresponding leak were recorded simultaneously. All patients underwent new CLPP measurement and a standard, complete urodynamic investigation, including filling cystometry with abdominal LPP and urethral pressure profile at rest. Statistical evaluation was done by linear regression analysis and the correlation coefficients among CLPP, age, standard abdominal LPP and maximum urethral pressure, and among the 3 measurements for each patient. : The assignment of leakage to the pressure signal presented no problem. All CLPP data were reproducible in the 3 repeated measurements per patient. No correlation was seen between CLPP and abdominal LPP or the urethral pressure profile. The study confirm that the CLPP is a practicable, consistent and minimally invasive method in routine use. Clinical use is easy and reproducible, and only 1 catheter is required for measurement.

496: Association Between Valsalva and Cough Leak Point Pressure with Pelvic Organ Prolapse in Female Stress Incontinence

You have accessJournal of UrologyPodium, Sunday, May 9, 2004, 10:00 am - 12:00 pm1 Apr 2004496: Association Between Valsalva and Cough Leak Point Pressure with Pelvic Organ Prolapse in Female Stress Incontinence Jerilyn M. Latini, M. Bridget Zimmerman, and Karl J. Kreder Jerilyn M. LatiniJerilyn M. Latini More articles by this author , M. Bridget ZimmermanM. Bridget Zimmerman More articles by this author , and Karl J. KrederKarl J. Kreder More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)37758-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "496: Association Between Valsalva and Cough Leak Point Pressure with Pelvic Organ Prolapse in Female Stress Incontinence." The Journal of Urology, 171(4S), p. 132 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 132 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Jerilyn M. Latini More articles by this author M. Bridget Zimmerman More articles by this author Karl J. Kreder More articles by this author Expand All Advertisement PDF DownloadLoading ...

Videourodynamic analysis of the relationship of Valsalva and cough leak point pressures in women with stress urinary incontinence

Objectives To use videourodynamic assessment to investigate the relationship between Valsalva leak point pressure (VLPP) and cough leak point pressure (CLPP) in women with stress urinary incontinence (SUI). Methods A total of 116 women with SUI were retrospectively analyzed by videourodynamic results, urethral pressure profilometry, and leak point pressure findings. All women had urine leakage during both coughing and performance of the Valsalva maneuver. The grade of SUI, VLPP, CLPP, maximal urethral closure pressure, and bladder neck descent during the stress test were compared among patients categorized according to three VLPP groups of less than 60 cm H 2O, 60 or greater but less than 90 cm H 2O, and 90 cm H 2O or greater. Results A significant inverse correlation was found between the grade of SUI and VLPP ( r = −0.620, P = 0.000) and CLPP ( r = −0.506, P = 0.000). The VLPP was less than 60 cm H 2O in 41 women, 60 or greater but less than 90 cm H 2O in 36, and 90 cm H 2O or greater in 39. The CLPP was greater than the VLPP in 101 women (87.1%) and equaled the VLPP in 15 women (12.9%). Of the 41 women with a VLPP less than 60 cm H 2O, 38 (92.6%) had a CLPP greater than the VLPP and 16 (39%) had greater bladder neck descent. The maximal urethral closure pressure had a weak but significant correlation with the VLPP ( r = 0.299, P = 0.011) and CLPP ( r = 0.325, P = 0.005). Conclusions The results of this study have demonstrated that the Valsalva maneuver and cough caused urinary leakage by different activities. A lower leak point pressure was found with VLPP than with CLPP to diagnose intrinsic sphincter deficiency. Complete assessment of urethral function, VLPP, CLPP, and bladder neck descent is essential for diagnosis and treatment of SUI.

Relationship between urinary profile of the endogenous steroids and postmenopausal women with stress urinary incontinence.

The aims of this study were to investigate whether endogenous steroid hormones are (1) related to pathogenesis of stress urinary incontinence after menopause, (2) are related to severity of stress urinary incontinence, and (3) are related to prognostic parameters of stress urinary incontinence. Twenty post-partum women with clinically diagnosed stress urinary incontinence and 20 age-matched postmenopausal women without stress urinary incontinence (control group) were evaluated. We compared urinary profile of the endogenous steroid hormones patients with stress urinary incontinence and controls, and between grade I and grade II of stress urinary incontinence. We also investigated the relationship between urinary profile of the endogenous steroid hormones and prognostic parameters of stress urinary incontinence (maximal urethral closure pressure, functional urethral length, Valsalva leak point pressure, cough leak point pressure, posterior urethrovesical angle, bladder neck descent, and stress urethral axis). The ages of the patients and those in the control group were 64.3 +/- 5.6 and 57.5 +/- 3.8 years old and the body mass indexes were 24.96 +/- 3.14 and 22.11 +/- 2.73 kg/m2 in patients and in normal subjects, respectively. Nine patients were grade I and 11 were grade II. Estrone and 17beta-estradiol only were detected in all subjects, regardless of control or patient group. It is noteworthy that there were no significant differences (P > 0.05) in the levels of estrone and 17beta-estradiol in the urine of postmenopausal normal subjects compared with in the urine of postmenopausal patients with urinary incontinence. E2/E1 ratio was not different between the two groups (P > 0.05). Among the objective steroids, DHEA, Delta4-dione, Delta5-diol, Te, DHT, 16alpha-DHT, 11-keto An, THDOC, and THB were not detected either in the urine of normal subjects and nor in the urine of the patients. After comparing androgen levels between normal subjects and patients, no significant differences (P>0.05) were detected, except for 5alpha-THB and 5alpha-THF. Neither 5alpha-THB or 5alpha-THF were detected in the patients' urine. Et/An (11beta-OH Et/11beta-OH An) concentration ratios were not significantly different between the two groups, either (P > 0.05). There were not significant differences of concentrations (micromol/g creatinine) of urinary steroids between grade I and grade II of stress urinary incontinence. Pregnanediol was significantly related to bladder neck descent in supine and sitting positions (R = 0.79, P = 0.01, and R = 0.73, P = 0.03, respectively), and pregnanetriol was significantly related to maximal urethral closure pressure and functional urethral length (R = 0.68, P = 0.04, and R = -0.79, P = 0.01, respectively). Androsterone was significantly related to bladder neck descent in supine and sitting positions (R = 0.68, P = 0.04, and R = 0.78, P = 0.01, respectively). 5-AT was significantly related to bladder neck descent in sitting position and stress urethral axis (R = 0.72, P = 0.03, and R = -0.71, P = 0.03). 11-keto Et was significantly related to bladder neck descent in supine and sitting positions and related to stress urethral axis (R = 0.82, P = 0.01, and R = 0.81, P = 0.01, R = -0.67, P = 0.04, respectively). THS was significantly related to bladder neck descent in supine and sitting positions and related to stress urethral axis (R = 0.76, P = 0.02, and R = 0.74, P = 0.02, R = -0.68, P = 0.04, respectively). THE was significantly related to bladder neck descent in sitting position (R = 0.67, P = 0.04).beta-Tetrahydrocortisol/alpha-tetrahydrocortisol (beta-THF/alpha-THF) and alpha-cortol were significantly related to maximal urethral closure pressure and functional urethral length (R = 0.74, P = 0.02, and R = -0.92, P = 0.01; R = 0.71, P = 0.36, and R = -0.87, P = 0.000, respectively). 17beta-estradiol (E2) was significantly related to bladder neck descent in supine position (R = -0.62, P = 0.04) and 17beta-estradiol/estrone (E2/E1) was significantly related to cough leak point pressure (R = 0.79, P = 0.01). In conclusion, the urinary concentrations of endogenous steroid metabolites in postmenopausal patients with stress urinary incontinence were not significantly different from normal patients and were not significantly different between grade I and grade II patients with stress urinary incontinence. Some endogenous steroid metabolites were positively or negatively significantly related to prognostic parameters of stress urinary incontinence.

Dynamic tests of the urethral sphincter closure and pelvic floor function

In the group of stress incontinent women (n = 54) the values of cough leak point pressure (CLPP) and Valsalva leak point pressure (VLPP) were studied together with urethral stress profiles. So as to evaluate the function of the pelvic floor during stress manoeuvers the electromyographic potentials were simultaneously recorded. It was verified, that the values of CLPP were significantly increased in comparison with VLPP (p < 0.01), while electromyographic potentials obtained by CLPP test were more powerful than those recorded by VLPP (p < 0.01-p < 0.005) in different subgroups. According to the results mentioned above it can be concluded, that the reaction of the pelvic floor differs significantly due to various stress manoeuvers, like coughing, Valsalva etc. These findings should be considered in evaluation of the type of dysfunction and of the appropriate surgical treatment.

Difference of Cough and Valsalva Maneuvers in the Dynamic Testing of Stress Urinary Incontinence

Purpose：The aim of the study was to evaluate the relationship between Valsalva leak-point pressure (VLPP) and cough leak-point pressure (CLPP) in the patients with stress incontinence and to determine the correlation between maximal urethral closure pressure(MUCP) and leak point pressure. 7)

Stress incontinence in women under 50: does urodynamics improve surgical outcome?

The aim of the study was to determine whether urodynamic testing improves the outcome of retropubic surgery in women aged 50 or younger. A retrospective study was undertaken of 212 women aged 50 or younger who underwent retropubic surgery at a medical school-affiliated hospital between February 1991 and July 1997. Excluded were patients with prior retropubic urethropexy and known low urethral closure pressures. The surgery was performed by one urogynecologist and two urologists. The minimal evaluation by the urogynecologist was a focused incontinence questionnaire, pelvic neurologic examination, pelvic floor grading, cough stress test, urinalysis, postvoid residual, cotton swab test and supine empty stress test. Full urodynamics consisted of uroflowmetry, subtracted cystometry, urethral closure pressure, cough leak-point pressure and cystourethroscopy. Subjective postoperative follow-up at 14 years was by annual questionnaire. The urogynecologist's patients were in group I (95 women with full urodynamic studies) and group II (36 women with minimal testing). The urologists' patients were in group III (81 women with a very minimal workup and cystourethroscopy). A review of seven variables revealed no difference between the groups. In terms of cured, improved and failed, there was also no difference in outcome. There was a difference in postoperative voiding problems (though not stress incontinence) in group III compared to group I (P= 0.005) and group II (P=0.002). Our conclusion was that all women with stress incontinence should undergo a careful minimal evaluation. In women aged 50 or younger urodynamic studies may be avoided unless there is significant stress incontinence, complex symptoms, a positive supine empty stress test, marked prolapse, or a history of prior retropubic urethropexy.

Valsalva leak point pressures in women with genuine stress incontinence: Reproducibility, effect of catheter caliber, and correlations with other measures of urethral resistance

OBJECTIVES: The Valsalva leak point pressure has been promoted as an alternative to urethral pressure profilometry as a measure of urethral resistance in women with genuine stress incontinence. Our aims were to evaluate the reproducibility of the Valsalva leak point pressure, to assess the effect of catheter caliber on the Valsalva leak point pressure, and to compare vesical Valsalva leak point pressure to other measures of urethral resistance.STUDY DESIGN: Sixty consecutive women with genuine stress incontinence underwent duplicate Valsalva leak point pressure determinations by use of 8F and 3F vesical and 8F vaginal catheters. Subjects also underwent a standard resting urethral pressure profilometry, cough leak point pressure determinations, and pressure-flow micturition studies.RESULTS: Leakage was demonstrated on both Valsalva maneuvers in approximately 80% of subjects with both catheters. In subjects who leaked with both strains there was an extremely high correlation between the test-retest Valsalva leak point pressure within both catheters. The intercatheter correlation between the 8F and 3F Valsalva leak point pressures was significant but much weaker than the intracatheter correlations; 8F Valsalva leak point pressures were significantly higher than 3F Valsalva leak point pressures, although there were individual exceptions to this observation. Urethral pressure profilometry measures and micturition opening pressures were poorly correlated with Valsalva leak point pressure. Cough and vaginal Valsalva leak point pressures were significantly correlated with vesical Valsalva leak point pressure, but cough leak point pressures were significantly higher and vaginal Valsalva leak point pressures were significantly lower than the vesical Valsalva leak point pressure.CONCLUSIONS: Valsalva leak point pressure is a simple and reproducible technique for evaluating urethral resistance in women with genuine stress incontinence. However, variations in Valsalva leak point pressure measurement must be precisely described, standardized, and validated before a technique can be advocated for clinical use.