Leak Point Pressure Measurement Research Articles

Recovery of Continence Function following Simulated Birth Trauma Involves Repair of Muscle and Nerves in the Urethra in the Female Mouse

BackgroundThe natural history and the mechanisms behind the alteration of vaginal distension (VD) in a mouse model are not clear. ObjectiveWe examined the temporal sequelae of VD and pudendal nerve transection (PNT) on leak-point pressure (LPP) and the muscular and nerve components of the urethra in mice. Design, setting, and participantsSeventy-two virgin female C57BL/6 mice were equally distributed into three groups. The VD group underwent VD for 1h. The PNT group received bilateral PNT. A control group underwent sham VD. InterventionEach group was divided into four subgroups of six mice for measurement of LPP at 0, 4, 10, and 20 d after VD or PNT. MeasurementsLPP was measured. Morphology and neurofilament-immunoreactive nerve of the urethra were assessed. Results and limitationsLPP was decreased at 0, 4, and 10 d but not at 20 d after VD. Decreased LPP persisted to 20 d in the PNT group. The external urethral striated muscle appeared disrupted and/or wavy in two mice at 0 d, in three mice at 4 d, in one mouse at 10 d, and in one mouse in 20 d after VD. The density of neurofilament-immunoreactive nerve in the urethra was reduced at 4 and 10 d after VD, but not at 20 d, and at 4, 10, and 20 d after PNT compared with the corresponding values of the sham VD group. The limitation of this animal model is that the pelvic floor structure of the mouse is different from that of female humans. Therefore, results of this study should be carefully applied to human subjects. ConclusionsVD causes reversible stress urinary incontinence in female mice. Recovery of continence function following VD is associated with repair of the external urethral sphincter and reinnervation of the urethra. This mouse model will be useful for mechanistic investigation and targeting of therapeutic intervention by taking advantage of genetic manipulation.

Pubo-Urethral Ligament Injury Causes Long-Term Stress Urinary Incontinence in Female Rats: An Animal Model of the Integral Theory

We examined the long-term effects of pubo-urethral ligament deficiency as a potential model of stress urinary incontinence compared to an established model of stress urinary incontinence. A total of 21 female Sprague-Dawley rats were randomly assigned to 1 of 3 groups, including pubo-urethral ligament transection, sham pubo-urethral ligament transection and bilateral pudendal nerve transection. Leak point pressure was measured 28 days later via an implanted suprapubic catheter. After leak point pressure measurement all animals were sacrificed. The pubic arch and pelvic organs were harvested for histological examination. The Wilcoxon rank sum test was used to evaluate differences in leak point pressure among the experimental groups. At 28 days after pubo-urethral ligament transection mean +/- SD leak point pressure was significantly decreased when comparing pubo-urethral ligament transection and pudendal nerve transection to sham treatment (15.75 +/- 6.46 and 15.10 +/- 4.98 cm H(2)O, respectively, vs 42.56 +/- 11.58, p <0.001). No difference was noted when comparing pubo-urethral ligament transection to pudendal nerve transection (p = 0.76), indicating the long-term durability of pubo-urethral ligament transection on inducing stress urinary incontinence in the female rat. Histological examination of en bloc suprapubic areas demonstrated an absent pubo-urethral ligament in the pubo-urethral ligament transection group, and an intact pubo-urethral ligament in the sham treated and pudendal nerve transection groups. Our results show that pubo-urethral ligament deficiency in the female rat induces long-term stress urinary incontinence that is comparable to that in the established stress urinary incontinence model via pudendal nerve transection. Our novel rat model could be used to investigate mechanisms of stress urinary incontinence in females, including the role of urethral hypermobility and potential therapeutic interventions for stress urinary incontinence.

Collagen Remodeling and Suburethral Inflammation Might Account for Preserved Anti-incontinence Effects of Cut Polypropylene Sling in Rat Model

To determine whether the inflammatory responses or collagen remodeling in suburethral tissue could have contributed to the preserved anti-incontinence effects of a cut polypropylene sling. Stress urinary incontinence was created in 60 age-matched female Sprague-Dawley rats that were subsequently randomized into 3 equal-size groups according to surgical procedure: placement of a vaginal suburethral sling, placement of a vaginal suburethral sling in which the suburethral portion of the sling was immediately cut, and sham surgery without placement of the sling. In a previous study, the leak point pressure measurements were obtained on these rats 6 weeks after surgery. The rats were then killed, the urethrovaginal tissue was harvested (cross-section of the entire urethra and anterior vagina) from 30 animals (10 from each experimental group), and the tissue was stained with hematoxylin-eosin and Masson's trichrome for histopathologic studies and picrosirius red for collagen fibers. As previously published, the median leak point pressures were similarly and significantly increased in the rats in the intact and cut sling groups compared with those in the sham surgery group. The inflammatory mediators and interstitial edema were similarly increased in the intact and cut sling specimens compared with the sham surgery specimens. Under polarized light, picrosirius red-stained specimens from the sham surgery animals appeared to be composed of collagen that predominately birefringed red to yellow (typical of type I collagen). The picrosirius red-stained cut and intact sling specimens appeared to contain collagen fibers that predominately birefringed green (typical of type III collagen). Histologic changes, including inflammation, localized edema, and differential collagen remodeling, might contribute to the preserved anti-incontinence mechanisms of cut or intact polypropylene slings observed clinically.

Development of a device to standardize leak point pressure experiments in rats

The objective of this study was to test a custom device aimed at increasing repeatability of abdominal leak point pressure (LPP) measurements in rodents. The device consisted of a soft-tipped force applicator with a force sensor which was moved in the vertical direction by a linear actuator, laser crosshairs for accurate positioning, and a hand-held wired remote control system. One expert and two novice experimenters acquired LPP measurements using manual and device methods by applying a gradually increasing force with the finger or the device, respectively, until a leak was visually observed at the urethral meatus. The device was tested at fast, medium, and slow speeds. A leak sensor was also tested to determine presence of a leak and reaction time of the user. The change in bladder pressure due to the externally applied force (LPP) was the primary outcome. There were no significant differences in mean LPP value when compared across experiments (expert, novice), method (manual, device), or speeds. The pooled variance of LPP was significantly decreased (P < 0.05) compared to the manual method when using the device at medium speed; however the slower speed showed no further improvement over the medium speed. The wet sensor detected leaks 385 +/- 187 msec earlier than users' reaction. Use of the device can decrease variability of the experiment but does not alter mean values. Reaction time, inherent in both the manual and device methods, has the potential for a significant impact on LPP outcomes.

Mid-term Outcome After Bulbourethral Composite Suspension for Postprostatectomy Incontinence

To report mid-term outcomes of bulbourethral composite suspension for postprostatectomy incontinence, which we have used for more than 6 years. A total of 57 men with a median (range) age of 67 (42 to 83) years underwent bulbourethral composite suspension with suprapubic and perineal incision, placement of a porcine dermis for urethral protection, and insertion of a polypropylene retropubic sling, which was tied suprapubically under urodynamic Valsalva leak point pressure measurement. Urinary stress incontinence was assessed preoperatively by clinical examination, urodynamic evaluation, urethrocystoscopy, and quality-of-life evaluation. Follow-up included a clinical examination, urodynamic evaluation, and quality-of-life evaluation. At a median (range) follow-up of 36 (3 to 74) months, 74% of patients reported having benefit from the operation, with significantly improved quality of life. Sixty percent of the patients (34 of 57) were totally continent, 14% (8 of 57) showed a significant improvement, and 26% (15 of 57) had no benefit. Intraoperative complications occurred in 21% (12 of 57) and consisted of bladder perforations, which healed spontaneously. No obstructive voiding symptoms due to de novo bladder outlet obstruction were observed. Bulbourethral composite suspension for postprostatectomy incontinence is an effective and safe method with high patient satisfaction. Mid-term follow-up at 3 years showed stable urinary continence and absence of detrusor decompensation. Bulbourethral composite suspension may become an alternative to the artificial sphincter for treatment of moderate and severe postprostatectomy incontinence.

Bladder and Urethral Sphincter Function after Radical Retropubic Prostatectomy: A Prospective Long-Term Study

ObjectiveIn a prospective study we analysed the 3-yr results of the effects of radical retropubic prostatectomy (RRP) on detrusor and sphincter function by comparing urodynamic status preoperatively with that during longitudinal follow-up. MethodsFifty-four consecutive patients underwent urodynamics with pressure flow studies and Valsalva leak point pressure measurements 3–7 d before RRP (baseline), and then 8 mo after surgery. Thirty-two patients were studied again 3 yr later. We analysed bladder compliance, detrusor overactivity (DO), detrusor contractility, and intrinsic sphincter deficiency (ISD). ResultsThere was a significant increase in the number of patients with reduced bladder compliance at the 8-mo follow-up. De novo reduced bladder compliance was detected in 32.3% of patients and persisted in 28.1% at the 36-mo follow-up. De novo detrusor hypocontractility was observed in 51% of patients at 8 mo (p<0.05) and persisted in 25% of cases 3 yr later. No patients showed any postvoid residual volume. The associations between detrusor hypocontractility with DO and between detrusor hypocontractility with ISD were detected in 76.2% and 44% of patients, respectively, at 8 mo, and in 25% and in 34% of cases, respectively, at 36 mo of follow-up (p<0.05 and p<0.001). ConclusionsFollowing RRP detrusor hypocontractility, decreased bladder compliance, and ISD represent de novo dysfunction probably due to bladder denervation during surgery. They become established conditions over time in about 30% of patients. Nevertheless, they do not produce voiding symptoms because patients develop new voiding behaviours.

What is the Variability in Urodynamic Parameters With Position Change in Children? Analysis of a Prospectively Enrolled Cohort

Insufficient data are available regarding the effect of patient position on urodynamic parameters and diagnoses in children. We report on a cohort of pediatric patients, comparing the results of serial urodynamic studies to determine the variability between the supine and sitting positions. Children referred for urodynamic evaluation were prospectively enrolled based on the ability to tolerate position change. Consecutive studies in supine and sitting positions were performed during a single session by the same nursing team. Volume infused and infusion rate did not differ with position change. A total of 48 children were enrolled in the study. Mean patient age was 10.4 years. No statistically significant difference was noted for maximum cystometric capacity, detrusor leak point pressures or pressure specific volumes at 20 and 30 cm water between the supine and sitting positions. Statistically significant lower values were found for the volume of first sensation and volume at which detrusor overactivity was first detected (p <0.05), with a trend toward significance for abdominal or Valsalva leak point pressure. Statistically significant differences were also noted with position changes in regard to detection of detrusor overactivity and incontinence episodes (p <0.05). In our study population no significant differences were detected in several urodynamic parameters with position change, suggesting that clinically valid conclusions can be obtained by performing the study in either position. Studies in the sitting position allow for increased detection of detrusor overactivity and incontinence, thus, being favored over the supine position if well tolerated by the child.

A mouse model of simulated birth trauma induced stress urinary incontinence

To facilitate future applications of transgenic or knockout technologies in studies of simulated birth trauma induced stress urinary incontinence (SUI), we aimed to create a mouse model of SUI and explore the possible pathogenesis of this condition. Thirty female C57BL/6 mice were randomly distributed into five groups. Four groups underwent vaginal distention (VD) for 1 hr, using a modified 6-Fr. Foley catheter with a balloon dilated to 0.3, 0.2, or 0.1 ml or sham distention. Four days after VD, all mice underwent leak-point pressure (LPP) measurement via an implanted suprapubic tube (SPT). The normal control group only had SPT placement and LPP measurement. After sacrifice, the urethras of the mice were harvested for routine histological examination and nerve staining. LPPs were significantly lower in groups after VD with 0.3- or 0.2-ml balloon than in control and sham distention groups (10.29 +/- 6.70, 14.65 +/- 6.51, 37.78 +/- 5.10, and 30.30 +/- 5.30 cm H(2)O, respectively). There were no significant differences in LPP between control and sham groups. Histology showed no significant differences in urethral striated muscle among the five groups. The density of immunoreactive neurofilaments in the urethra decreased after VD with 0.3- or 0.2-ml balloon. As a model of birth trauma, VD can induce SUI in female mice, the severity of which is related to intravaginal balloon size. Partial urethral denervation plays a plausible role in the pathogenesis of SUI. This novel mouse model could be used for further mechanistic studies of female SUI.

Mini-invasive collagen sling in the treatment of urinary incontinence due to sphincteric incompetence

To assess the technical feasibility of mini-invasive sling procedure and present preliminary results in the treatment of urinary incontinence due to sphincteric insufficiency. Thirteen patients (6 males, 7 females, 8 with myelomeningocele, 1 with tethered spinal cord, 3 with bladder exstrophy, 1 with epispadias) underwent sling procedure with porcine dermis acellular collagen matrix (Pelvilace, Bard medical, UK). The median age was 15.5 (range 8.9-27.5) years. A suprapubic catheter was inserted for the measurement of leak point pressure during the operation. In females vaginal and in males perineal incision was used for sling insertion. The sling was introduced under cystoscopic control. The sling was not fixed with sutures. The outcomes were reviewed at 1, 6 and 12 month after the operation. The median leak point pressure increased from 21.5 (range 5-25) cm H2O to 85 (range 70-100) cm H2O. At 1 month 8 and at 6 months 3 out of 13 patients were dry. At 12 months, none out of 11 patients was completely dry. However, at 12 months some improvement in incontinence was detected in 9 out of 11 patients. Two patients had primary failures. One patient got sling erosion to urethra after a tightening attempt. In one patient detrusor overactivity increased after the sling procedure. Pelvilace sling is safe and easy to introduce in both males and females if pelvic floor anatomy is normal. Although immediate results were promising in neuropathic incontinence, the results seem to deteriorate to unacceptable low level already during the first year. In exstrophy patients the results are generally poor.

Clinical and demographic factors associated with valsalva leak point pressure among women undergoing burch bladder neck suspension or autologous rectus fascial sling procedures

Many parameters have been utilized to try to estimate severity of stress urinary incontinence (SUI). Valsalva leak point pressure (VLPP) measurements, have been proposed as a reliable means of gauging the severity of SUI during urodynamic studies (UDS). Certain, non-invasive, measures of incontinence severity have been proposed, but the correlation of these measures with VLPP is not known. In addition, the correlation of other important UDS measures and VLPP has not been evaluated. In this study we sought to define the relationship between demographic characteristics, physical exam findings, and non-sphincteric UDS measures with VLPP in a large multicenter randomized surgical trial comparing Burch urethropexy and fascial sling for the treatment of SUI. Pre-surgical, standardized urodynamic measures were obtained in all participants in the Stress Incontinence Treatment Efficacy Trial (SISTEr) trial. All UDS were assessed for quality assurance and protocol compliance. VLPP was assessed using a <8 Fr water transducer catheter during graded Valsalva maneuvers at 200 ml, and then at 100 ml intervals and bladder capacity if no SUI was noted earlier. Only data from women who had SUI on at least two of three consecutive valsalva maneuvers was utilized for this analysis. Delta VLPP was determined as the average value, and the baseline vesical pressure was subtracted from the absolute vesical pressure to arrive at the reported VLPP value. Independent variables studied to assess their relationship to VLPP value included demographic characteristics (age, number of pregnancies, # vaginal deliveries, hormone usage, previous hysterectomy, previous SUI surgery), physical exam parameters [body mass index--BMI, Pelvic Organ Prolapse-Quantified POPQ stage, POPQ Aa measurement, Q-tip angle (rest) and Q-tip angle (strain), and change in angle], and other urodynamic parameters (volume of first leakage, volume at first sensation, presence of detrusor overactivity, maximum cystometric capacity--MCC, maximum flow rate--Q(max), and detrusor pressure at maximum flow rate--pdet.Q(max)). Among the 655 women randomized, 424 were found to have evaluable VLPPs. Thirty-four had stage 3 or 4 prolapse and were excluded from the VLPP analysis. The remaining 390 women had a mean VLPP of 81.1 cm H(2)O. On bivariate analysis, there were significant positive associations with VLPP and BMI (P = 0.026), Q-tip straining angle (P = 0.0002) change in Q-tip angle (P = 0.0046), MCC (P < 0.0001) and pdet.Q(max) (P = 0.0003). Age was negatively associated with VLPP (P < 0.0001). For categorical values, lower POPQ stage (0/1), post menopausal status, and use of hormones were all associated with lower VLPP values. For example, patients with stage 2 had, on the average, VLPP values that were more than 10 cm H(2)O greater than those with stage 0/1. On multivariate analysis, however, only lower age, greater BMI, greater MCC, greater pdet.Q(max), and lower Q(max) were found to be independent associated with higher delta VLPP. Advancing age, lower BMI, higher maximum flow rate, and lower voiding pressures are all independently associated with lower VLPP in women undergoing surgery for SUI. Lower voiding pressures and higher flow rates among women with more severe SUI may reflect the chronic loss of urethral resistance associated with SUI. Interestingly, urethral hypermobility as assessed by Q-tip testing angle does not achieve a statistically significant association with VLPP on multivariate testing when controlling for POP-Q stage. Thus, as clinically suspected, the Q-tip test is not predictive of VLPP in women with urethral hypermobility and SUI.

The Relationships Among Measures of Incontinence Severity in Women Undergoing Surgery for Stress Urinary Incontinence

We assessed the relationships among severity measures of urinary incontinence in women with stress predominant symptoms enrolled in a randomized clinical trial comparing 2 surgical techniques (Burch colposuspension vs pubovaginal sling) for stress urinary incontinence. A total of 655 women underwent a standardized preoperative assessment that included the Medical, Epidemiological and Social Aspects of Aging questionnaire, Urogenital Distress Inventory, Incontinence Impact Questionnaire, 3-day voiding diary, 24-hour pad test, a supine empty bladder stress test and Valsalva leak point pressure measurements. Correlations were estimated using Spearman correlation coefficients and 95% confidence intervals. T tests at alpha=0.05 were conducted to compare the distributions of the continuous severity measure between patients with positive and negative supine empty bladder stress test. Baseline mean scores on Medical, Epidemiological and Social Aspects of Aging, Urogenital Distress Inventory and Incontinence Impact Questionnaire were 25.8, 151 and 171, respectively. Mean incontinence episode frequency and pad weight were 3.2 per day and 43.5 gm, respectively. Supine empty bladder stress test was positive in 218 patients, and 428 patients had valid Valsalva leak point pressure measurements with a mean Valsalva leak point pressure of 80 cm H(2)O. Weak to moderate correlations were observed between Medical, Epidemiological and Social Aspects of Aging, incontinence episode frequency, pad weight, Incontinence Impact Questionnaire and Urogenital Distress Inventory. On the other hand, Valsalva leak point pressure correlated poorly with all variables measured. The sensitivity and specificity of the supine empty bladder stress test to predict intrinsic sphincter dysfunction were 49% and 60%, respectively. Urinary incontinence severity measures correlate moderately with each other at best. While Medical, Epidemiological and Social Aspects of Aging demonstrated stronger correlations with the other measures of severity and quality of life, Valsalva leak point pressure did not. Supine empty bladder stress test did not demonstrate a clinically significant association among severity measures.

Effects of Injection Therapy using Muscle Derived Stem Cell/ Chitosan/ Hydroapatite Composite Gel in a Rat Model of Urinary Incontinence

Purpose: We investigated whether periurethral injections of musclederived stem cells (MDSC) and chitosan/hydroapatite after denervation of rat's pudendal nerve could increase the leak point pressure over a long time period in a rat model of urinary incontinence. Materials and Methods: Muscle-derived stem cells isolated from the gastrocnemius muscle of normal female rats were purified to obtain a myogenic population by using the preplate technique. The N group was the normal female rats, the D Group was the pudendal nerve transected group and the M Group was the MDSC/chitosan/hydroapatite composite gel injected group after pudendal nerve transection. The MDSC/chitosan/hydroapatite composite gel was injected into the proximal periurethral area. At 2 and 4 weeks, visually identified leak point pressure measurement was done with using the vertical tilt/intravesical pressure clamp model of urinary incontinence. The rats were then sacrificed and the periurethral tissues harvested for histological examination. Results: The leak point pressure was significantly lower in the D group at each time compared with the N group, and the leak point pressure in the N and M groups were significantly higher than those in the D group at both 2 and 4 weeks. The persistence of MDSC over the period of study was verified by histological examination. Conclusions: MDSC/chitosan/hydroapatite injection into the denervated external urethral sphincter in female rats increased the leak point pressure at 2 and 4 weeks. This MDSC/chitosan/hydroapatite composite gel can be an alternative injection method for treating urinary incontinence in the future. (Korean J Urol 2007;48:627-632) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Periurethral Injection of Sustained Release Basic Fibroblast Growth Factor Improves Sphincteric Contractility of the Rat Urethra Denervated by Botulinum-A Toxin

We evaluated the effects of sustained release basic fibroblast growth factor injection in rat urethra denervated by botulinum-A toxin (Wako Life Science, Osaka, Japan). A total of 30 female Sprague-Dawley rats underwent periurethral injection of 10 U botulinum-A toxin to induce chemical denervation of the urethral sphincter. Leak point pressure in the waking state was determined and a significant decrease in leak point pressure vs that in control rats was confirmed (mean +/- SD 58.7 +/- 6.2 vs 120.7 +/- 13.0 cm H(2)O, p <0.0001). Two weeks later 0, 50 and 200 microg basic fibroblast growth factor incorporating 200 microl gelatin hydrogels in 10 rats each were injected into the urethral sphincter, enabling sustained release of basic fibroblast growth factor for 2 weeks. Four weeks later injection leak point pressure measurement and histological evaluation of the urethra were performed. Leak point pressure in rats with 50 and 200 microg basic fibroblast growth factor injection was significantly higher than in rats with the 0 microg injection (82.7 +/- 9.0 vs 95.1 +/- 6.2 and 119.3 +/- 8.1 cm H(2)O, p = 0.0021 and <0.0001, respectively). Maximum cross-sectional area of the urethral smooth muscle layer in the 50 and 200 microg groups significantly increased compared with that in the urethra in the 0 micro group, which was considered 100% (114.1% +/- 15.8% and 132.5% +/- 13.4%, p = 0.029 and <0.0001, respectively). Similarly the cross-sectional area of the striated sphincter in the 50 and 200 microg groups was greater than the 100% in the 0 microg group (112.3% +/- 15.6% and 124.3% +/- 14.1%, p = 0.069 and 0.0007, respectively). Vascular density in the urethral peri-atrophic zone in the 50 and 200 microg groups was significantly higher than in the 0 microg group (p = 0.027 and <0.0001, respectively). Sustained release basic fibroblast growth factor injection in the chemically denervated urethral sphincter facilitates regeneration of the urethral muscles and improves sphincteric contractility. Endoscopic periurethral injection of basic fibroblast growth factor incorporating gelatin hydrogels may be an attractive therapy for stress urinary incontinence.

Interrater Reliability of Filling Cystometrogram Interpretation in a Multicenter Study

As part of a continuous quality control effort to measure the interrater reliability of urodynamic studies performed at multiple centers, we compared agreement levels for urodynamic studies between central and local physician reviewers. We report interrater reliability findings for the filling cystometrogram. Following a satisfactory interrater reliability study among 4 central physician reviewers in 33 tracings 36 urodynamic study tracings from 9 Urinary Incontinence Treatment Network continence treatment centers and 13 Urinary Incontinence Treatment Network certified urodynamic study testers were randomly selected for review. These tracings were originally interpreted by 11 local physician reviewers using standardized Urinary Incontinence Treatment Network interpretation guidelines. Each of the 4 central physician reviewers reviewed 9 randomly assigned tracings and none reviewed tracings from his or her center. Local and central physician reviewers were instructed to categorize values as invalid if specified technical quality assurance standards were not met or the signal pattern suggested implausible values because of technical deficiencies. An intraclass correlation coefficient was calculated for continuous (numerical) variables and a kappa statistic was calculated for qualitative values with acceptable agreement defined a priori as an intraclass correlation coefficient of greater than 0.6. Filling cystometrogram baseline pressure, Valsalva leak point pressure, and volume and pressure measurements at maximum cystometric capacity had excellent intraclass correlation coefficients of 0.74 to 0.99. There were no significant differences between local and central physician reviewer means, indicating excellent agreement. With proper quality control measures in place and a set of standardized interpretive guidelines excellent interrater reliability between local and central physician reviewer can be achieved for numerical cystometrogram variables.

Development of a device for measurement of leak point pressure in anesthetized rats

Development of a device for measurement of leak point pressure in anesthetized rats

Comprehensive urodynamics evaluation of 146 men with incontinence after radical prostatectomy

Objectives To assess the filling, storage, and voiding urodynamic parameters in a large group of men with urinary incontinence after radical prostatectomy. Methods We reviewed the videourodynamics testing results for 146 consecutive men referred for urinary incontinence after radical prostatectomy. Results The mean patient age was 69.0 years (range 48 to 85), and the mean interval since radical prostatectomy was 4 years (range 4 months to 19 years). All but four tests were performed more than 12 months postoperatively. Stress urinary incontinence (SUI) was demonstrated in 139 men (95%), with a mean abdominal leak point pressure of 59 cm H 2O. A statistically significant correlation was found between the leak point pressure and static urethral pressure profilometry measurements ( r = 0.46, P <0.0001). The mean urethral pressure profilometry measurements in those with SUI were significantly lower than in those without (46.6 versus 69 cm H 2O, P = 0.001). A total of 34 patients had diminished compliance or detrusor instability, but this was the sole finding in only 3. A hypocontractile detrusor response was seen in 49 patients, and 35 of these augmented voiding by abdominal straining. Patients with previous radiotherapy (n = 24) were more likely to have bladder outlet obstruction; the other parameters were similar to those in patients without radiotherapy. Conclusions Incontinence after radical prostatectomy is caused by intrinsic sphincter deficiency in the vast majority of patients. Urethral pressure profilometry measurements correlated with the severity of SUI, as measured by abdominal leak point pressure. Bladder outlet obstruction may coexist with SUI in a significant portion of patients. During voiding, a hypocontractile detrusor response may be seen, but the clinical significance of this finding is unclear.

Urethrale Funktionsteste: Was bringen sie uns wirklich?

Introduction: Various urethral function tests are available such as direct urethral pressure measurement, leak point pressure measurement and urethral resistance measurement. Aim of the study was to give an overview and a critical review of the current literature. Method: A medline search was perfomed using the expressions urethra pressure profile, urethra function test, leak point pressure and urethral resistance pressure between 1975 and 2004. Results: 86 articles could be identified giving an overview of direct urethral pressure measurement, functional urethral length, pressure transmission ratio, leak point pressure and urethral resistance measurement. Only URP (urethral retro resistance pressure) correlated with the severity of urodynamic stress incontinence but with one publication only. Discussion: There is no single urethral function test which is capable of distinguishing between urethral dysfunction and other mechanisms. However, urethral function tests are useful to predict postoperative outcome after incontinence procedures in patients with low pressure urethra and in scientific studies.

A new technique combining both polypropylene and vaginal wall sling procedures: can it minimize the risk of urethral and vaginal erosion occurring with synthetic materials?

We describe a new technique combining in situ vaginal wall and polypropylene mesh slings that may decrease potential erosive complications caused by synthetic materials. A folded mucosal patch harboring the polypropylene mesh was placed between mid-urethra and bladder neck. Using this technique, 12 consecutive women (age range 44-66 years) were operated. Preoperative evaluation included a detailed history, pelvic examination, stress test, cystourethroscopy, basic urodynamic evaluation (cystometry, Valsalva leak point pressure measurement), and urine culture. Based on these evaluations, three, seven, and two patients had type I, II, and III stress urinary incontinence, respectively. A paraurethral cyst excision was carried out in one patient and anterior colporrhaphy in four patients during the same operation. No ischemia or sloughing at the operation site occurred in any case. Pelvic examination was repeated in all patients after 3 and 6 months of follow-up and symptoms were determined after 12 months of follow-up in eight patients by telephone interview. Average follow-up was 10 months (range: 6-14 months). None of the patients were incontinent, or complained of sexual dysfunction or erosive complications after 1 year. Since there are two distinct barriers between the sling and both urethra and vagina, our technique covers all advantages of a sling procedure with synthetic materials and avoids the risk of urethral and vaginal erosion. The other advantage of this technique is the concomitant utilization of the vaginal wall as sling material.

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 ...

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