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

ABSTRACT

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.