Correlation of Valsalva Leak Point Pressure and Maximum Urethra Closure Pressure in Patients with Stress Urinary Incontinence

PURPOSE: The valsalva leak point pressure (VLPP), a quantitative measure of sphincteric function, is used widely to diagnose intrinsic sphincter deficiency (ISD). This study was to evaluate the correlation between VLPP and maximum urethra closure pressure (MUCP) in patients with stress urinary incontinence. MATERIALS AND METHODS: We divided the patients into two categories: 60 patients affected by ISD as they had stress incontinence; 80 patients suffering from stress incontinence without ISD. The presence/absence of ISD was considered the dependent variable and was correlated against the following independent variables: age, vaginal deliveries, menopause, previous urogynecological surgery, VLPP, MUCP, and functional urethral length (FUL). This two groups were compared VLPP with MUCP to evlauate their correlation. RESULTS: The statistical analysis showed close correlation between ISD and age (p=0.045), urogynecological surgery (p=0.013), VLPP (p=0.000), MUCP (p=0.000), FUL (p=0.000). There was statistically significant relationship between VLPP and MUCP (p=0.01), however a correlation coefficient of 0.303 demonstrated poor clinical relationship. When the cut-off value of MUCP were 20, 30, 40 cmH2O, there was no the diagnostic value of ISD. CONCLUSION: The MUCP has statistically significant relationship with VLPP but, low correlation coefficient demonstrated poor clinical relationship. Therefore, it is not clinically useful to evaluate urethral sphincter function.

The Relationship between Urethral Hypermobility and Valsalva Leak Point Pressure, Subjective Symptom Degree in the Patients with Stress Urinary Incontinece

PURPOSE: To evaluate the relationship between urethral hypermobility and Valsalva leak point pressure (VLPP), subjective symptom degree in women with stress urinary incontinence. MATERIALS AND METHODS: 229 patients who were diagnosed as stress urinary incontinence and had undergone all of standing cystourethrogaphy, urodynamic study including VLPP, and recording questionnaire of incontinence were included in this study. The subjective degree of stress urinary incontinence was graded to 3 grades by Stamey classification, and urethral mobility more than 2.0 cm on standing cystourethrography was determined as the urethral hypermobility. And patients were stratified 3 groups according to the VLPP of less than 60, 60 to 90 and greater than 90 cmH2O. Correlation between urethral hypermobility and VLPP, subjective symptom degree were evaluated. RESULTS: According to the VLPP of less than 60, 60 to 90 and greater than 90 cmH2O, urethral hypermobility was noted in 49.4%, 86.6%, 92.4%, respectively. The rate of urethral hypermobility increased according to VLPP does with statistical significance (p<0.05). And in subjective symptom grade I, II, III urethral hypermobility was noted in 75.0%, 79.7%, 61.0%, respectively. There was not significant correlation between urethral hypermobility and subjective symptom degree (p=0.15). CONCLUSION: Our results suggest that there is significant correlation between urethral hypermobility and VLPP. And in some of patients with stress urinary incontinence urethral hypermobility and intrinsic sphincter deficiency are coexist. However, we suggest that the preoperative evaluation for urethral hypermobility and intrinsic sphincter deficiency is needed to assess the surgical outcome more exactly in the patients with stress urinary incontinence.