Preoperative Valsava leak point pressure may not predict outcome of mid-urethral slings: analysis from a randomized controlled trial of retropubic versus transobturator mid-urethral slings

OBJECTIVE: To test the hypothesis that preoperative Valsalva leak point pressure (VLPP) predicts long-term outcome of mid-urethra slings for female stress urinary incontinence (SUI). MATERIALS AND METHODS: One hundred and forty-five patients with SUI were prospectively randomized to two mid-urethra sling treatments: Tension free vaginal tape (TVT) or transobturator tape (TOT). They were followed-up at 3, 6, 12 months post-operatively and then annually for the primary outcome variable, i.e. dry or wet and secondary outcome variables such as scores on the urogenital distress inventory (UDI-6) and the impact of incontinence on quality of life (IIQ-7) questionnaire as well as patient satisfaction as scored on a visual analogue scale (VAS). Preoperative VLPP was correlated with primary and secondary outcome variables. RESULTS: Mean follow-ups were 32 + 12 months (range 12-55) for TVT and 31 + 15 months (range 12-61) for TOT. When patients were analyzed according to VLPP stratification, 95 (65.5 percent) patients showed a VLPP > 60 cm H2O and 50 (34.5 percent) patients had a VLPP < 60 cm H2O. The overall objective cure rates were 75.8 percent for patients with VLPP > 60 cm H2O and 72 percent for those with VLPP < 60 cm H2O (p < 0.619). No significant differences in objective cure rates emerged when patients were stratified for pre-operative VLPP and matched for TOT or TVT procedures: VLPP > 60 cm H2O (82 percent vs. 68.9 percent p < 0.172); VLPP < 60 cm H2O (68 percent vs. 76 percent p < 0.528). CONCLUSIONS: When patients were stratified for preoperative VLPP (< or > of 60 cm H2O), preoperative VLPP was not linked to outcome after TVT or TOT procedures.

Tension Free Vaginal Tape Procedure in Incontinent Patients with Low Valsalva Leak Point Pressure

PURPOSE: To evaluate the outcome after the tension free vaginal tape (TVT) procedure in stress urinary incontinence with low Valsalva leak point pressure (VLPP), and identify factors predicting the outcome. MATERIALS AND METHODS: Two hyndred twenty-one women from 29 to 80 years old (mean 55.2) were included in the study. The TVT procedure was mostly performed under local anesthesia. The mean follow-up time was 10.5 months (range 6~52). Patients were divided into two groups (Group I: VLPP or = 60 cmH2O, n=160). Cure of incontinence was defined as the absence of a subjective complaint of leakage and the absence of objective leakage on stress test. RESULTS: The overall cure rate was significantly lower in Group I than in Group II (82.0% versus 93.1%, p= 0.013). In women with low VLPP, multivariate analysis indicated that urge symptom and low maximal urethral closure pressure were independent factors for the treatment failure: (odds ratio, 15.12; 95% confidence interval, 1.90~120.61; p=0.010) for urge symptom and (odds ratio, 0.92; 95% confidence interval, 0.86~0.99; p=0.018) for maximal urethral closure pressure. CONCLUSION: The cure rate after the TVT procedure is lower in women with low VLPP, when compared to those with higher VLPP. Our findings suggest that urge symptom and low maximal urethral closure pressure should be considered to be at high risk of the failure after the TVT procedure in these patients.

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. MATERIALS AND METHODS: Thirty women with stress urinary incontinence were included. Two women were excluded from the evaluation because of detrusor instability. At the bladder volume of 200-300ml cough leak-point pressure and Valsalva leak-point pressure were measured in the sitting position by using 8Fr intravesical catheter. RESULTS: Valsalva leak-point pressure was significantly lower than cough leak-point pressure (69.4+/-24.5 versus 86.6+/-28.1cmH2O, p<0.0001). If intrinsic sphincter deficiency was defined as a leak-point pressure of 60cmH2O or less, 21.4% of women fulfilled this criterion using the cough leak-point pressure compared to 42.8% if the Valsalva leak-point pressure is used. Valsalva leak-point pressure and maximal urethral closure pressure were statistically correlated (p<0.05). However, a correlation coefficient of 0.38 demonstrated poor clinical relationship. CONCLUSION: Cough leak-point pressures were significantly higher than Valsalva leak-point pressures. Cough and Valsalva maneuvers seem to result in a different reaction of the pelvic floor. Valsalva leak-point pressure has more statistical correlation to the maximal urethral closure pressure than cough leak-point pressure. So Valsalva leak-point pressure may have a additional benefit for detecting type III stress urinary incontinence. However, variations in Valsalva leak-point pressure measurement must be precisely descibed, standardized, and validated before a technique can be advocated for clinical use.

Correlation of Valsalva Leak Point Pressure with Clinical and Urodynamic Characteristics in Women with Stress Urinary Incontinence

PURPOSE: To determine whether specific clinical and urodynamic characteristics can be used to identify women with stress urinary incontinence(SUI) due to intrinsic sphincteric deficiency, we assessed correlation between Valsalva leak point pressure(VLPP) and other clinical and urodynamic parameters. MATERIALS AND METHODS: A prospective analysis was performed of 108 patients who underwent urodynamic evaluation for complaints of urinary leakage. Intrinsic sphincteric deficiency (ISD) was defined as a VLPP of 60cmH2O or less at 150-250ml filling of the bladder. Anatomic incontinence(AI) was defined as a VLPP of 90cmH2O or high. Patients with VLPP between 60 and 90cmH2O were excluded in this study. All patients were evaluated with symptom grade(Stamey), duration of symptom, age, body weight, parity, functional urethral length(FUL) and maximum urethral closure pressure(MUCP). Correlation of VLPP and these parameters were computed. RESULTS: Of the 108 patients, 50 had ISD and 58 had AI. In ISD group, SUI was grade I in 14%, II in 48% and III in 38%. There were significant differences in the incidence between grade I and grade II or III. In AI group, SUI was grade I in 43%, II in 45% and III in 12%. There were significant differences between grade III and grade I or II. The two groups were similar in all other preoperative clinical and urodynamic characteristics. CONCLUSIONS: The only preoperative clinical index that can predict the presence of intrinsic urethral sphincter dysfunction, as defined by VLPP, was severity of symptom. Higher grades of stress urinary incontinence have a higher likelihood of a low VLPP.

The Correlation of Valsalva Leak Point Pressure Maximum Urethral Closure Pressure and Urethral Hypermobility according to Symptom Grade in the Diagnosis of Genuine Stres Incontinence

PURPOSE: We evaluated the correlation of Valsalva leak point pressure, maximum urethral closure pressure, and urethral hypermobility in the diagnosis of genuine stress incontinence. MATERIALS AND METHODS: From January 1997 to January 1999, one hundred thirteen patients with genuine stress incontinence had undergone three measures determined in a standardized fashion. We compared three parameters with symptom grades of genuine stress incontinence. RESULTS: Of the total 113 patients, genuine stress incontinence were grade I in 39, II in 43 and III in 31. There were significant difference in the incidence between grade III and grade I or II in Valsalva leak point pressure, maximum urethral closure pressure, and urethral hypermobility(p<0.05). Valsalva leak point pressure was the most significnat correlation with symptom grade(r=0.4), but there were not correlation among Valsalva leak point pressure, maximum urethral closure pressure, and urethral hypermobility in grade III geniune stress incontinence patients and 66.7% of grade III genuine stress incontinence patients had urethral hypermobility. CONCLUSIONS: With these results, Valsalva leak point pressure is good indicator for intrinsic sphincter deficiency. But intrinsic sphincter deficiency should be diagnosed by composites of historic, urodynamic, anatomic, and other clinical factors.

Valsalva Leak Point Pressure in Female Stress Urinary Incontinence: Reproducibility and Correlation with Maximum Urethral Closure Pressure / 대한비뇨기과학회지

PURPOSE: The valsalva leak point pressure(VLPP), a quantitative measure of sphincteric function, is used widely to diagnose intrinsic sphincteric deficiency. The purpose of this study was to assess the reproducibility of VLPP and to evaluate the correlation between VLPP and maximum urethral closure pressure(MUCP) in patients with stress urinary incontinence. MATERIALS AND METHODS: Thirty consecutive women with urodynamically confirmed genuine stress urinary incontinence underwent duplicate VLPP measurements. Inter-personal reproducibility of VLPP recording was obtained by two urologists in fifteen women. Intra-personal reproducibility of VLPP recording was obtained by one urologist in fifteen women. Each test was performed with two weeks interval, and was blinded to the previous results. Two hundred sixty two women with stress urinary incontinence were evaluated prospectively, comparing MUCP with VLPP to evaluate their correlation. RESULTS: Repeated measurements of VLPP were reproducible. Intra-personal agreement was excellent with a correlation coefficient of 0.95(p=0.0001) between the first and second examination. Inter-personal correlation coefficient was 0.85(p=0.0001). The difference between repeated measurement was not statistically significant. There was a statistically significant relationship between VLPP and MUCP(p=0.0001), however a correlation coefficient of 0.29 demonstrated poor clinical relationship. CONCLUSIONS: The VLPP is a simple and reproducible methods for evaluating urethral resistance in stress urinary incontinence. The MUCP has statistically significant relationship with VLPP, however it is not clinically useful to evaluate urethral sphincter function because women with normal or high MUCP had leakage at low VLPP and vice versa.

Long-term Results of Bladder Neck Suspension: Valsalva Leak Point Pressure as a Predictive Factor of Surgical Outcome in Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: We retrospectively reviewed the cases of female stress incontinence at our institution to evaluate the value of VLPP(valsalva leak point pressure) in predicting surgical outcome of BNS(bladder neck suspension). MATERIALS AND METHODS: Ninety-four female patients with stress incontinence who underwent BNS after urodynamic study were investigated retrospectively. Surgical outcomes and patient?s satisfaction were assessed by questionnaires. Surgical outcomes were then analyzed in relation to VLPP and MUCP(maximal urethral closing pressure). Follow-up averaged 27 months. RESULTS: Mean age was 50 years and mean parity was 2.9. Urinary incontinence completely disappeared in 36 patients(38.2%), significantly improved in 29 patients(30.9%), failed in 29 patients(30.9%). There was a significant relationship between VLPP and failure rate. The failure rate was 44.8%(p=0.015) in patients with low VLPP(< or =60cmH2O) and 36.4%(p=0.67) with low MUCP(< or =20cmH2O). CONCLUSIONS: We conclude that VLPP is superior to MUCP in predicting surgical outcome after bladder neck suspension for female stress incontinence. This study demonstrates that bladder neck suspension is not a effective procedure for surgical correction of intrinsic sphincter deficiency, therefore another treatment modality should be considered. VLPP is a useful guide in selecting appropriate surgical modality on female stress urinary incontinence.

Clinical Usefulness of Valsalva Leak Point Pressure as a Diagnostic Tool in Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The valsalva leak Point pressure(VLPP) has been suggested as an objective tool for diagosing female stress urinary incontinence(SUI) accompained by intrinsic sphictor deficiency(ISD) Our aims were to determine the predictive value of VLPP in patients with ISD and correlation between VLPP and other parameters as a diagnostic tool for ISD. MATERIAL AND METHODS: Sixty-seven patients with stress urinary incontinence were evaluated propectively with symptom grade(Stamey grade). Q-tip test, 1hr pad test, and VLPP. Correlations of VLPP and these clinical parameters were computed. VLPP of 60cm H2O was determined as a cut-off value of ISD and compared with other parameters(symptom grade, hypermobility). RESULTS: Of the total 67 patients, SUI was grade lin 20(29.8%) ll in 32(47.8%) and lllin 15(22.4%). Of the 67 patients, 48 had VLPP of more than 60cmH2O. Among these, SUI was grade l in 20(100%), ll in 26(81.3%) and lllin 2(13.3%). There were significant differences in the incidence between grade llland grade l or ll (P<0.01). Of the 19 patients with VLPP of 60cmH2O or less, SUI grade lllin 77 in 13(86.7%); where SUI was grade lin 0(0%) and ll in 6(18.7%) with statistical significance between grade llland grade l or ll. Urethral hypermobility was noted in 56(83.6%); this was l in 20(100%), ll in 26(81.8%) and lllin 10(67%). Among the SUI patients without hypermobility, none had symptoms of grade l: whereas 33.3% of grade lllpatients didn't show hypermobility. There appeared significant correlation(p<0.001) between the VLPP and symptom grade(correlation coefficient=0.68). Moderate correlations were present between either symptom grade or VLPP and amount of urine leakage(correlation coefficient=0.5). No statistically significant relationship existed between either VLPP or symptom grade and urethral hypermobility. CONCLUSION: subjective degree(such as symptom severity or amount of urine loss) of stress incontinence seems useful in predicting the likelihood of low valsalva leak point pressure which suggests intrinsic sphinctor deficiency. By the result that some women of grade ll incontinence with urethral hypermobility exhibited low VLPP, measurement of VLPP could be a valuable tool in choosing the treatment modality of stress urinary incontinence.

Transurethral approach to collagen injection in the female stress incontinence; Procedure of choice?

No abstract available.